A Comparison of Treatment Options in Focal Post-Stroke Spasticity of the Upper Extremity: A Prospective Longitudinal Cohort Study from Kerala, India.

ABSTRACT

Background: Post-stroke 20%-40% of patients develop spasticity which can quadruple total cost of care. This impact can be reduced by affordable treatment options for focal spasticity. Objectives: The primary objective of the study was to compare changes in Passive Range of Movements in patients with focal post-stroke spasticity from pre-treatment to end of 1 month of treatment with anti-spastic agents. The secondary objectives were to measure the changes in Modified Ashworth, and Brunnstrom Recovery Staging during the same period. Materials and Methods: This prospective longitudinal cohort study was conducted in a tertiary level rehabilitation center. One hundred and three adults with post-stroke spasticity participated. The patients received one of the four options Phenol, Onabotulinum toxin, Bupivacaine and Hyaluronidase.The main outcome measures were the following Changes in Passive Range of Movement (PRoM), Brunnstrom staging (BRS) and Modified Ashworth Scale (MAS). Result: Post intervention testing at 1 month was done. Each agent significantly improved BRS (1.10, 95% CI 0.8-1.4, P = 0.001) and PRoM (32.28, 95% CI 27.66- 36.89, P = 0.001), while reducing MAS (0.39, 95% CI 0.01-0.77, P = 0.05). In addition, subgroup comparisons were done with phenol as a reference for all three outcome measures. There was a significant difference in the improvement of Brunnstrom staging for Bupivacaine (0.52, 0.094-0.95, 0.02) compared to phenol. Similarly, Hyaluronidase showed better improvement in MAS (0.39, 0.01-0.77, 0.05) compared to Phenol. Conclusion: There was a significant difference in PRoM, MAS and Brunnstrom staging from baseline to end of 1 month long anti-spasticity treatment.