Early clinical predictors of post-stroke spasticity

Background and Purpose: Up to 40% of stroke patients with paresis develop post-stroke spasticity (PSS), which induces difficult complications including pain, contracture, posture disorder. The most important factor for PSS management is its early initiation, so that early recognition of PSS is required in clinical practice. Methods: This prospective observational cohort study was conducted with a high standard of PSS assessment and a comprehensive protocol investigating possible predictive factors to identify early predictors of PSS already in the acute phase following stroke (<7 days). PSS was assessed with the Resistance to Passive movement Scale (REPAS) for major joint movements in upper- and lower limbs, based on Ashworth scale, within 7 days following stroke and after 3 months. Binary logistic regression analysis with significant clinical parameters was applied with 95% of confidence intervals (CI) to find predictors of PSS. Results: Of 145 consecutive first-ever stroke patients, 34 patients (23.4%) exhibited PSS. The Modified Rankin Scale (MRS), National Institutes of Health Stroke Scale (NIHSS), and Mini-Mental State Examination (MMSE) were revealed as strong clinical predictors of PSS. The combination of an MRS >2 (Odds Ratio (OR): 56.538, 95% CI: 17.150-186.394), NIHSS >2 (OR: 57.137, 95% CI:15.685-208.142) and MMSE <27 (OR: 6.133, 95% CI:2.653-14.178) showed positive predictive (95.2%) value for prediction of PSS (sensitivity 94.4%, specificity 93.3%). Conclusions: Besides evaluating PSS itself with a reliable and valid rating scale the common clinical scales in stroke units practice (NIHSS, MRS, MMSE) allow early identification of patients at high risk for PSS.