Prevalence and Management of Poststroke Spasticity in Thai Stroke Patients: A Multicenter Study
Piyapat Dajpratham MD*, Vilai Kuptniratsaikul MD*, Apichana Kovindha MD**, Patcharawimol Srisa-an Kuptniratsaikul MD***, Kalaya Dejnuntarat BSc*
Affiliation : * Department of Rehabilitation Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Bangkok, Thailand *** Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Objectives: To study the prevalence, associated factors and management of poststroke spasticity in two muscle
groups namely elbow flexor and knee flexor.
Material and Method: The Thai stroke rehabilitation registry (TSRR) was conducted among 9 rehabilitation
centers. All subjects received the conventional rehabilitation program until they reached their rehabilitation
goals or discharge criteria. The Brunnstrom motor recovery stage, Barthel Index, Thai Mental State
Examination, Modified Ashworth Scale (MAS), and WHOQOL-BREF-Thai(26 items) questionnaires were
used to assess the motor recovery, functional disability, cognition, spasticity and quality of life on admission
respectively. The management of spasticity was also recorded.
Results : There were 327 patients with a mean age of 62.2 years old participating in the study. The prevalence
of poststroke spasticity was 41.6%. Among these the prevalences of spasticity of both elbow and knee flexors
was 31.2% and of either elbow or knee flexor were 4.9% and 5.5% respectively. Spasticity with MAS grade 1
was found in the majority. The patients with spasticity had a significantly longer time to rehabilitation
admission interval after the stroke (p = 0.049), had the Brunnstrom motor recovery stages of arm (p < 0.001),
hand (p = 0.003) and leg (p < 0.001) significantly lower than the no spasticity group. The factor associated
with spasticity was Brunnstrom motor recovery stage 2 and 3 of the arm with the odds ratio being 6.1 (95% CI
= 2.5-14.9) and 3.5 respectively (95% CI = 1.3-9.2). Management of spasticity was demonstrated in 83
patients (25.4%). Therapeutic exercise, oral antispastic medication and assistive device were the first three
managements frequently prescribed respectively.
Conclusion : Spasticity was a common complication after stroke. Although the prevalence was quite high,
spasticity with MAS grade 1 was found in the majority of cases. The associated factor was the Brunnstrom
motor recovery stage of the arm. Therapeutic exercise was the mainstay of the management.
Keywords : Muscle spasticity, Prevalence, Risk factors, Stroke, Therapy
