Clinical Interventions in Aging (May 2020)
A Simple Bedside Screening Tool for Spasticity Referral
Abstract
Mallory L Hacker,1,2 Shelby Ploucher,1,3 Aaditi G Naik,1,4 Maxim Turchan,1 Jacqueline C Meystedt,1 Kelly Harper,1 Peter Hedera,1 Claude J Pirtle,5 Kassandra Stubblefield,1 David Charles1 1Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; 2Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA; 3Florida State University College of Medicine, Tallahassee, FL, USA; 4Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA; 5Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USACorrespondence: Mallory L HackerNeurology and Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, 440 Crystal Terrace, 3319 West End Ave, Nashville, TN 37203, USAEmail [email protected] and Objectives: Spasticity is common in long-term care facilities; however, this often-disabling condition is largely underdiagnosed in this setting and therefore left untreated. This study aimed to test the ability of a three-question flowchart used at the bedside by primary care providers in the long-term care setting to identify residents in need of referral to a specialist for spasticity consultation.Methods: All residents of a single long-term care facility were approached for participation in this cross-sectional, observational study. Spasticity diagnostic evaluations by a movement disorders specialist neurologist (reference standard) were compared with referral determinations made by two primary care providers [a primary care physician (PCP) and a nurse practitioner (NP)] using the simple flowchart.Results: The analysis included 49 residents (80% male, age 78.2± 9.0 years) who were evaluated by the reference standard neurologist and at least one primary care provider. The bedside referral tool demonstrated high sensitivity and moderate specificity when used by the PCP (92% and 78%, respectively; AUC=0.84) and NP (80% and 53%, respectively; AUC=0.67).Conclusion: This simple tool may be useful for primary care providers to identify residents to be referred to a specialist for evaluation and treatment of spasticity. These results warrant further investigation of the potential utility of this screening tool across multiple long-term care facilities and various types of care providers.Keywords: spasticity, neurological disease, long-term care, screening, primary care
