Article

OBJECTIVE: To conduct a systematic review of the published evidence on the
relationship between spasticity and quality of life (QOL) in chronic neurological
conditions in adults.
DATA SOURCES: MEDLINE, Embase, CINAHL and PsycINFO databases. METHODS:
The databases were searched from inception to October 2014
using keywords 'spasticity' and 'quality of life' for publications in English
language. Cross-sectional and longitudinal studies reporting quantitative
analyses on the association between spasticity and QOL were included. Appraisal
of the studies and data extraction were conducted in accordance with
Strengthening the Reporting of Observational Studies in Epidemiology guidance.
RESULTS: 17/652 studies (total of 27 827 patients) met inclusion criteria for
review. These examined the relationship between spasticity and QOL in multiple
sclerosis (MS), spinal cord injury (SCI) and stroke. Spasticity was found to be
associated with significantly lower scores on health status measures, namely
SF-12, SF-36 and EQ-5D, in MS and SCI, but less so in stroke. Spasticity was
associated with considerably lower scores on physical components of the health
status questionnaires, but with only marginally lower scores on mental
components. The studies that employed global QOL measures, such as the World
Health Organisation Quality of Life - BREF, found no significant relationship
between spasticity and QOL. Spasticity was often associated with pain, sleep
problems, fatigue and urinary dysfunction. CONCLUSIONS: Spasticity is associated
with worse health status, however its relationship with overall QOL is not
established. The relationship between spasticity and QOL is confounded by other
impairments and requires multivariate analysis. Implications for Rehabilitation
Effective management of spasticity may result in significant improvements in
HRQOL. It is important to address multiple factors in the management of
spasticity including pain, bladder problems, fatigue and sleep, as the interplay
of these may have significant negative effects on HRQOL. Clinician-administered
methods for measuring spasticity, such as the Ashworth scale, may not provide
comprehensive assessment of spasticity. Incorporation of patient-reported
measures for spasticity is pivotal in the assessment of therapeutic
interventions.

Langue : ANGLAIS