Effect of Spasticity on Quality of Life in Patients with Spinal Cord Injury
Dongre, Amruta A 1987-
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The basic goal of any rehabilitation program is to restore function and to improve quality of life. In patients with spinal cord injury, spasticity is one of the major complications which affects quality of life. The use of an Intrathecal Baclofen (ITB) pump to treat spasticity has recently increased. Even though ITB treats spasticity, it results in various complications and is very expensive. It is important to examine the long term benefits of ITB in improving quality of life along with spasticity in patients with spinal cord injury. In this study, we have compared the Quality of Life (QoL) and patient reported impact of spasticity in first time ITB pump users and those who have had it re-implanted. We have examined the relationship between patient reported impact of spasticity and QoL. We have also compared the physician’s evaluation of spasticity with patient’s perception of spasticity. 36 patients with tetraplegia having an ITB pump implant (14 patients who were on their first pump as well 22 patients who have it re-implanted) were selected from TIRR Memorial Hermann’s ITB pump clinic in Houston, TX. Clinical assessment for spasticity was performed by a clinician or nurse, and the clinical scales including World Health Organization Quality of Life- BREF (WHOQOL-BREF), Patient Reported Impact of Spasticity Measure (PRISM), and the Pump Complications Questionnaire were administered by the Principal Investigator via telephone. Independent t-tests were performed to compare the group differences (first time pump users versus individuals with re-implants) in each subscale of WHOQOL-BREF, each subscale of PRISM, and MAS. The level of significance was set at p< .05. It was noted that there were no significant group differences in both WHOQOL-BREF and PRISM subscales. The results indicate that as the spasms get worse it limits the ability to perform ADL, causes psychological distress, social embarrassment, and in turn affects an individual’s health, quality of life, interaction with the environment and the society. The correlation between the PRISM subscales and MAS revealed that only social avoidance and social embarrassment significantly correlated with MAS furthermore suggesting that spasticity negatively affects an individual social relationships and social interaction.