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.
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 inmultiple 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.
So spasticity is a not surprising associated with poor outcomes on quality of life and therefore developing treatments to deal with this issue should be of benefit.
However, proving things are of benefit is a problem.
The Ashworth scale which is a physician assessed scale is rather insensitive to subtle change and many treatments have failed to affect this measure, but the FDA in the US seem to be hung up that this needs to be affected for approval. In Europe they have accepted numerical rating scales that are patient assessed so the bar has been set lower and so Europeans are more likely to get anti-spastics. As medical cannabis is an add-on to other drugs it is going to be hard to show an effect on the Ashworth.
However, it seems it is green lights in the US for stoner medicine and there is seems like the burden of proof goes out the window. I used to go to a meeting focused on cannabis research, but it is getting more and more frequented by stoner pot growers, who when asked where is the evidence that it is useful for this or that condition the stock answer is “I know I tried it on myself.”
Now , I have no beef with medical cannabis users but you need to keep a professional relationship, and not come out with bongs at meetings based in the Neherlands, or bring someone in Canada who has a medical use….or go off and “medicate”. It taints the science however