Focal Spasticity Management: Guidelines, usual care & outcomes

• 
  
  Ms Edwina Sutherland

  edwina.sutherland@epworth.org.au

• 
  
  Prof Gavin Williams

  gavin.williams@epworth.org.au

Project Details

Focal muscle spasticity is a disabling neurological impairment. The presence of spasticity in upper or lower limb muscles can limit task performance, as well as impact quality of life and broader societal participation. For those diagnosed with neurological conditions such as stroke, traumatic brain injury or multiple sclerosis, muscle spasticity can affect as many as two thirds of people, creating a large personal and economic burden.

There are at least twenty-five national and international clinical practice guidelines, consensus statements and Cochrane reviews which outline recommendations for the management of focal muscle spasticity. We recently conducted a systematic review, titled “A synthesis and appraisal of clinical practice guidelines, consensus statements and Cochrane systematic reviews for the management of focal spasticity in adults and children”. A few key themes emerged including, but not limited to, aspects of care such as:

1. Input from an experienced multi-disciplinary team.
2. Treatment that is patient-centred.
3. Therapy should be goal-directed and involve the patients, family and caregivers.
4. Outcomes should be evaluated using SMART principles and ICF frameworks.

Despite this growing body of evidence guiding clinicians in the management of focal muscle spasticity, the variable scope and quality of these guidelines and consensus statements makes it difficult to apply the recommendations in clinical practice. In the absence of a single consolidated set of guidelines, Victorian clinics may currently manage focal muscle spasticity in different ways. Additionally, although there are several Cochrane reviews in relation to focal spasticity, their scope is narrow, and the majority of clinical practice guidelines and consensus statements are based on expert opinion rather than evidence. Ultimately, there is little evidence to support a majority of the recommendations for focal spasticity or whether implementing the guidelines is associated with better patient outcomes.

Therefore, the primary objective of this project is to identify which components of focal spasticity management constitute ‘usual care’ in Victorian spasticity clinics. Specifically, the main aims are to:

• Document usual care in spasticity clinic appointments
• Determine which components of care are associated with better patient outcomes

Researchers

• Prof Gavin Williams
• Dr Bridget Hill
• Dr Fiona Dobson
• Edwina Sutherland

Collaborators

• Stephen Ashford
• Steffen Berwick
• Klemens Fheodoroff
• Brian Hoare
• Tandy Hastings-Ison
• Barbara Singer

Funding

The project team have received a philanthropic grant of $100,000 through the Epworth Healthcare.

Research Outcomes

Williams G, et al. A synthesis and appraisal of clinical practice guidelines, consensus statements and Cochrane systematic reviews for the management of focal spasticity in adults and children. Disability and Rehabilitation. 2020. DOI: 10.1080/09638288.2020.1769207