An assessment of the management of spasticity in Spain: the 5E Study

Introduction. Although spasticity is a disabling complication of high incidence, there is a lack of either regional or national epidemiological studies in Spain evaluating its management. Aim. To evaluate the management of spasticity in Spain. Patients and methods. An epidemiological, observational, multicenter, and retrospective study involving 49 rehabilitation services of public and private hospitals was designed. Results. Two hundred and thirty-five patients from 49 centers, with evidence of upper (UL) or lower limb (LL) spasticity with one valid baseline visit and at least one follow-up visit, were included. Among the patients included in the study 148 (62.9%) have post stroke spasticity; 79 (33.6%) have LL spasticity, 38 (16.1%) UL, and 118 (50.3%) in both. At baseline, Modified Ashworth Scale, goniometry, Visual Analog Scale for pain and Tardieu Scale had been performed in 164 (69.8%), 99 (42.1%), 85 (36.2%), and 26 (11.1%) patients, respectively. A 93.8% (IC 95%: 81.4-97.6%) of the centers accurately defined the treatment goals and 52% of the objectives were agreed with the patient. Botulinum A toxin was administered in 186 (79.1%) of patients; 49 (20.9%) patients were treated with oral antispastic medications and 93 (39.6%) were under physiotherapy treatment. Conclusions. Most of the patients have post-stroke spasticity. Moreover, botulinum A toxin was the most commonly treatment applied to patients with spasticity. The results demonstrate that the management of spasticity varies significantly across the different centers participating in the study.