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Norbye A.D.1,2, Thrane G.3
1UiT The Arctic University of Norway, Faculty of Health Sciences, Tromsoe, Norway, 2Molde Hospital, Moere and Romsdal Health Trust, Department of Neurology, Molde, Norway, 3UiT The Arctic University of Norway, Department of Health and Care Sciences, Tromsoe, Norway
Background: Spasticity is a symptom caused by pathological changes in the central nervous system, and affects over 80 % of people with Multiple Sclerosis. Spasticity is known to reduce quality of life, give additional symptoms such as pain and reduced mobility, but the association between spasticity, balance and mobility has not yet been established. There is no consensus on how spasticity should be measured. Previous studies exploring this correlation have mostly focused on spasticity in the ankle plantar flexors.
Purpose: The aim of this study was to examine if there was a relationship between spasticity in the lower limbs, balance and gait. The study also wanted to explore the direction of the association. Additionally, the study examined if the most used measurement tool, Modified Ashworth Scale, was appropriate to find an association.
Methods: Thirty patients with MS were included in this study, and the study was conducted with a cross-sectional design. For measuring spasticity, Modified Ashworth Scale (MAS) was used to examine spasticity in the ankle plantar flexors, knee extensors and hip adductors. Balance was measured using the Mini-Balance Evaluation Systems Test (Mini-BESTest) and gait was measured with 2-minute walk. The participants were tested once, with no additional follow-up.
Results: The results showed a significant correlation between balance function and spasticity in ankle plantar flexors, knee extensors and hip adductors. Gait distance was significantly associated with spasticity in the ankle and quadriceps musculature. The association was moderate to high, with spasticity explaining up to 45 % of the results in the clinical measures. Neither sex, age nor years since diagnosis were significant confounders to the balance results, but sex correlated with the gait results.
Conclusion(s): In conclusion, spasticity showed a moderate to high correlation with mobility measures such as gait and balance. The results from this study suggest that Modified Ashworth Scale is an appropriate measurement tool to measure spasticity.
Implications: The results from this study indicate that patients have reduced mobility due to spasticity. The reduction in gait and balance parameters significantly correlates also with low degree of spasticity. This can indicate that treatment should be considered from onset of spasticity. There is also an ongoing debate on how spasticity best can be treated. To explore effects of treatment, it is important to have a measurement tool that is associated with functions important to patients. In this study, MAS was found to be a measurement tool that correlated with mobility measures. This implicates that MAS can be used as an objective measure to follow-up over time. One advantage of MAS is that it is easy to implement, both in clinical practice and in research. This use can improve and enable the evaluation of treatment and effect.
Funding acknowledgements: No funds were received in support of this work.
Topic: Neurology: multiple sclerosis
Ethics approval: The study was approved by the Norwegian Centre for Research Data with project number 43393.
All authors, affiliations and abstracts have been published as submitted.
