MossRehab Jefferson Health, Elkins Park, PA, USA.
MedStar National Rehabilitation Network and Georgetown University School of Medicine, Washington, DC, USA.
J Rehabil Med. 2023 Oct 5;55:jrm4257. doi: 10.2340/jrm.v55.4257.
Describe how people with lower limb spasticity present for treatment in routine clinical practice.
Prospective, observational study (Clinicaltrials.gov: NCT04050527) of ambulatory adult patients (≥ 18 years) with unilateral lower limb spasticity (able to take ≥ 5 steps with or without assistance) presenting for routine spasticity management, including treatment with abobotulinumtoxinA.
The study population included 430 adults with lower limb spasticity. Despite their relatively young age (mean ± standard deviation 53.7 ± 13.9 years), only 20% of patients were employed. Most patients had an acquired brain injury due to cerebrovascular disease; 84.1% reported having concomitant upper limb spasticity. Using the Leg Activity Measure, most patients reported no or only mild difficulties in performing hygiene/positioning tasks, while 80.7% had at least mild difficulty with indoor ambulation and 90.5% had at least mild difficulty with walking outdoors. Sensory, communication and/or cognitive impairments were also common. At the first treatment cycle, 50.7% of patients set active function primary goals, including locomotion transferring or standing.
These observations highlight the complexity of presentation that must be considered when setting treatment goals for lower limb spasticity and emphasize the types of impairment and activity (functional) limitations that treating teams may expect to encounter in their patients and should cover in their initial and follow-up assessments.
描述在常规临床实践中下肢痉挛患者的就诊情况。
前瞻性、观察性研究（Clinicaltrials.gov：NCT04050527）纳入了 430 名单侧下肢痉挛（能独立或辅助行走≥5 步）的门诊成年患者（≥18 岁），这些患者存在下肢痉挛，正在接受常规痉挛管理，包括接受阿博特利珠单抗治疗。
研究人群包括 430 名下肢痉挛患者。尽管他们相对年轻（平均±标准差 53.7±13.9 岁），但只有 20%的患者有工作。大多数患者因脑血管病而患有获得性脑损伤；84.1%的患者报告同时存在上肢痉挛。使用下肢活动测量量表，大多数患者报告在进行个人卫生/体位转换任务时无困难或仅存在轻度困难，而 80.7%的患者在室内行走至少存在轻度困难，90.5%的患者在户外行走至少存在轻度困难。感觉、沟通和/或认知障碍也很常见。在第一个治疗周期中，50.7%的患者设定了主动功能的主要目标，包括转移或站立行走。
这些观察结果强调了在为下肢痉挛设定治疗目标时必须考虑的就诊复杂性，并强调了治疗团队在患者中可能遇到的损害类型和活动（功能）受限，这些内容应在他们的初始和随访评估中涵盖。
