What is the role of outcome measures in spasticity treatment?

Updated: Mar 01, 2018
  • Author: Krupa Pandey, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Measures designed to assess technical and functional outcomes, patient satisfaction, and the cost-effectiveness of treatment can be used to evaluate status and track changes in spasticity management. While double-blind, placebo-controlled studies remain the standard for clinical testing, the single-subject design is a useful alternative in many treatment protocols.

However, the development of validated and reliable outcome measures for spasticity rehabilitation has been hampered by the difficulty of quantifying functionally important parameters such as pain, ease of care, and mobility. Because no single tool can measure the many types of changes possible with treatment, the choice of assessment tools must be based on the functional changes expected from the treatment. A wide range of assessment tools have been reviewed critically for their sensitivity, reliability, validity, and ease of administration. [55]

Most spasticity rating scales are ordinal. Equal intervals between units on an ordinal scale cannot be assumed automatically. Noninterval scaling can be addressed using Rasch analysis, though care must be taken to avoid inappropriate extrapolation. Ratio scales, such as before/after measurements, are useful, reliable, and easy to administer.

A technical outcome is an expected change in a measurable variable, based on the technical goals of a procedure. A functional outcome is an expected change in a patient's ability to perform a task. Patient satisfaction measures are concerned with both the result and the process of care delivery. The choice of test must be based on the change expected, and the sensitivity must match the range of expected improvement. Otherwise, the results will be meaningless. Changes in technical measures of spasticity may not correlate well with clinical improvement.


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