Prevalence and Effect of Problematic Spasticity After Traumatic Spinal Cord Injury

Objective To evaluate the prevalence and effect of spasticity after traumatic spinal cord injury (SCI). Design Prospective cohort study of the Rick Hansen Spinal Cord Injury Registry (RHSCIR) and retrospective review of inpatient medical charts. Setting Quaternary trauma center, rehabilitation center, and community settings. Participants Individuals (N=860) with a traumatic SCI between March 1, 2005, and March 31, 2014, prospectively enrolled in the Vancouver site RHSCIR were eligible for inclusion. Interventions Not applicable. Main Outcome Measures Questionnaires (Penn Spasm Frequency Scale, Spinal Cord Injury Health Questionnaire) and antispasticity medication use. Results In 465 patients, the prevalence of spasticity at community discharge was 65%, and the prevalence of problematic spasticity (defined as discharged on antispasticity medication) was 35%. Problematic spasticity was associated with cervicothoracic neurologic level and injury severity (P<.001). In community follow-up, the prevalence of patients reporting any spasticity treatment (ie, problematic spasticity) was 35% at 1 year, 41% at 2 years, and 31% at 5 years postinjury. Interference with function caused by spasticity was reported by 27% of patients at 1 year, 25% at 2 years, and 20% at 5 years postinjury. Patients with American Spinal Injury Association Impairment Scale grade C injuries had the highest prevalence of ongoing spasticity treatment and functional limitation. Conclusions Spasticity is a highly prevalent secondary consequence of SCI, particularly in patients with severe motor incomplete cervicothoracic injuries. It is problematic in one third of all patients with SCI up to 5 years postinjury. One in 5 patients will have ongoing functional limitations related to spasticity, highlighting the importance of close community follow-up and the need for further research into spasticity management strategies.