LYON, FRANCE—Intrathecal baclofen (ITB) therapy and inpatient rehabilitation can produce meaningful gains in functional independent measures (FIM) that indicate improved functional outcomes, according to researchers.
Spasticity reduction can be accompanied by FIM gains. The FIM gains can reduce patient time for functional task completion, caregiver burden, and caregiver time. Spasticity-related impact on daily activities and independence in multiple sclerosis (MS) patients can be effectively treated with ITB, reported Barbara Bumstead, an adult nurse practitioner at South Shore Neurologic Associates in Patchogue, New York, and colleagues. “With reduced caregiver burden and caregiver time, economic gains might be realized in these MS patients with severe spasticity who have significant care needs,” the researchers said.
Spasticity is common in patients with MS. It can be a significant cause of disability leading to pain, loss of mobility, decreased quality of life, and increased morbidity. Oral medications to treat spasticity in MS, although widely available, may be ineffective or poorly tolerated and are often discontinued by patients due to side effects or lack of efficacy. ITB therapy allows for selective targeting of reflex excitation of spinal neurons with minimal, if any, side effects on cortical neurons, which cause lethargy. ITB therapy delivers medication through a catheter placed directly into the thoracolumbar thecal sac.
This therapy can provide safe and effective spasticity control. ITB therapy has demonstrated benefit across a wide range of measures including measures of spasticity, gait, pain, fatigue, and quality of life. Specific changes related to gains in FIM in MS patients have not been reported. A five-point decrement in FIM correlates with the need for about one hour per day of help with mobility and basic activities of daily living. Ms. Bumstead and colleagues conducted a retrospective analysis of mean change in FIM for MS patients admitted for inpatient rehabilitation immediately following ITB implantation. Data from individuals with MS who underwent ITB implant and subsequent inpatient rehabilitation admission in one facility throughout a five-year period were retrospectively evaluated.
The researchers identified 36 patients—25 female (69%); mean age, 51; average length of stay, 13 days. Mean improvement of one-point change in items of the FIM score was seen for grooming, bathing, arm dressing, leg dressing, bladder, bowel, bed-chair/wheelchair transfer, walking, and stairs; a two-point improvement was found in toilet transfer; and a three-point improvement was observed in tub-shower transfer. A mean change score of 23.23 for FIM total of 23.23 was seen over 18 care items.
—Glenn S. Williams
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