The Investigation For Prevalence And Risk Factors Of Post-stroke Spasticity

Purpose:Via investigating the clinical characteristics of post-stroke spasticity, the aim of present study is to determine the prevalence and factors predictive of spasticity after stroke and to provide reference for early treatment of spasticity in clinical, reduce the morbidity of post-stroke spasticity and improve the patients’ quality of life.Methods:We preliminarily designed a questionnaire to collect data on the basis of spasticity related literature and experienced physiatrists’ comments. Then we used the questionnaire to collect data of stroke patients transferred or admitted to the Fujian University of Traditional Chinese Medicine subsidiary Rehabilitation Hospital between February 2014 and May 2015. Spasticity was assessed by the Modified Ashworth Scale (MAS), and patients were divided into spasticity group and non-spasticity group. The content of the questionnaire included: gender, age, schooling level, occupation/work; previous stroke, stroke type, lesion side, stroke duration, operative treatment, associated diseases, pain, hemihypesthesia; lesions location extent of the lesion; activities of daily living and NIHSS score. Using the muscle tone classification as the dependent variable, a multiple logistic regression analysis was then performed to explore the independent factors associated with post-stroke spasticity.Results:The trial included 702 stroke patients, and we found that a total of 303 stroke patients showed spasticity signs. The incidence of post-stroke spasticity was 43.2%, including mild spasticity (MAS=1 or 1+) 26.2%, moderate spasticity (MAS=2)12.0% and severity spasticity (MAS>3) 5.0%. Univariate analysis showed that gender, age, previous stroke, stroke type, lesion side, stroke duration, operative treatment, pain, hemihypesthesia, extent of the lesion and NIHSS score 11 factors that affect the occurrence of post-stroke spasticity (P <0.05). Multivariate logistic regression analysis showed that gender, age, stroke duration, pain, hemihypesthesia and NIHSS score were the factors predictive of spasticity after stroke. Comparing with male stroke patients, female stroke patients (OR=0.631) had a lower incidence of spasticity; Comparing with those below 39-year-old, the older stroke patients had a lower incidence of spasticity with the increasing of the age(the OR of 40-49-year-old, 50-59-year-old,60-69-year-old,70-79-year-old and >80-year-old were 0.761,0.697,0.492, 0.525 and 0.241); Comparing with acute phase (within 1 month) of stroke patients, with the development of stroke, the incidence of post-stroke spasticity were higher (the OR of subacute phase (1-3 months), the recovery (3-6 months) and the sequelae period (> 6 months) were 1.137,1.599 and 1.981); Comparing with stroke patients without pain, patients suffering from pain (OR=2.278) had a higher incidence of spasticity; Comparing with those without hypoesthesia, patients with hypoesthesia (OR=2.364) had a higher incidence of spasticity; Comparing with NIHSS≤4, the higher scores of NIHSS had a higher incidence of post-stroke spasticity (the OR of NIHSS score within 5-8,9-11 and >12 were 1.053,1.706 and 2.147).Conclusions:Post-stroke spasticity is one of disabling complications caused by multiple factors. Gender, age, stroke duration, pain, hemihypesthesia and NIHSS scores, were significantly predictive of spasticity after stroke. Male, young, long stroke duration, with pain, hemihypesthesia and high NIHSS scores were the risk factors of post-stroke spasticity. More attention should be payed to the prevention of post-stroke spasticity, especially for the patients with high-risk. Health education, avoiding factors induced spasticity, and early application of anti-spasticity posture and anti-spasticity therapy could reduce the incidence of post-stroke spasticity.