SAN DIEGO—About 20% of stroke patients suffer some level of spasticity; but according to Chris Kozma, PhD, "the impact of spasticity on poststroke patients' quality of life has not been thoroughly investigated." At the 52nd Annual Meeting of the American Academy of Neurology, Dr. Kozma said "it is an expected conclusion that [stroke patients] with spasticity have a lower quality of life than people with stroke alone." The clinical impact may be understated, however, because "the correlation between the standard measures of spasticity and quality of life are generally low."

To assess the impact, Dr. Kozma and colleagues used the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). They compared SF-36 scores of patients with poststroke spasticity with published SF-36 scores of stroke patients without spasticity, patients with other chronic diseases (hypertension, diabetes, or congestive heart failure), and the general population.

Patients with poststroke spasticity had lower SF-36 scores for physical functioning, role limitations due to physical problems, and social functioning than did stroke patients without spasticity. The difference in scores ranged between 20 and 40 points. Patients with poststroke spasticity also scored lower than patients with hypertension or congestive heart failure. Patients with poststroke spasticity had lower scores for general mental health than did patients with hypertension but had higher scores for general mental health and vitality than did patients with congestive heart failure.

The decrements in quality of life faced by poststroke spasticity patients are significant, said Dr. Kozma, who is Senior Research Director for Strategic Outcomes Services, Research Triangle Park, North Carolina. His group also examined how well standard measures of spasticity correlated with SF-36 scores. Canonical correlation analysis was used to compare SF-36 scores with traditional clinical measures such as Ashworth scores, the Functional Independence Measure, and a pain and functional disability assessment. Only a moderate correlation was seen between the SF-36 and Ashworth variates and between the SF-36 and the pain and functional disability assessment.

According to Dr. Kozma, "standard clinical measures only assess a portion of the overall quality of life, and they rarely focus on specific issues like pain or physical function." Further, he suggested that issues of patient care be examined from both a clinical and a patient perspective. "The use of clinical and quality-of-life measures, together, may improve the ability to plan effective care for patients with poststroke spasticity," he said. "This is a call for instrument development: We need better clinical measures of spasticity and better disease-specific measures of quality of life also."

—Kathryn Blair

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