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Original report

Improving the management of post-stroke spasticity: Time for ACTION

Gerry CHRISTOFI, BSc(Hons), BM BCh, PhD, Stephen ASHFORD, BSc, MSc, PhD, Jonathan BIRNS, BSc, MBBS, PhD, Catherine DALTON, MD, Lynsay DUKE, BSc, MA(PED), Claire MADSEN, MSc and Sohail SALAM, MBBS, MRCS, MSc (Hons) Anatomy


DOI: 10.2340/20030711-1000004

Abstract

Objective: To identify barriers to appropriate referral and treatment for patients with spasticity and present solutions that address these in a pragmatic way.
Methods: Using the findings of interviews conducted with UK healthcare professionals on the management of post-stroke spasticity, a consensus meeting was held involving 7 UK spasticity experts. The panel identified barriers to timely identification and referral of patients in the acute and post-acute care settings. Barriers were prioritized using a consensus framework based on impact and resolvability and a series of final recommendations were agreed.
Results: High-priority barriers broadly related to: insufficient awareness of spasticity symptoms and benefits of treatment, limited access to spasticity services and lack of standardized pathways for post-stroke spasticity identification. Potential solutions included the appointment of an experienced member of the acute team to gain expertise in spasticity identification, patient education of spasticity symptoms and a greater utilization of training resources for healthcare professionals.
Conclusion: To address the barriers identified, we provide a series of consensus recommendations. As a key recommendation, we propose a set of indicators for the identification of stroke patients requiring specialist assessment and the use of the associated acronym “ACTION”.

Lay Abstract

People who have a stroke may suffer from complications such as spasticity (stiffness in muscles due to muscle contraction). Spasticity can cause difficulty with day-to-day activities and may also cause pain. People with stroke may have spasticity without it being diagnosed, and people who need treatment may not be seen by healthcare professionals. Through formal consultation and analysis with expert doctors, physiotherapists and occupational therapists a range of simple and practical recommendations to help improve treatment is proposed. An acronym ‘ACTION’ was developed, referring to limitation of Activity, difficulty with Care tasks, Tight muscles, Integrity of the skin, Ongoing pain and Nails digging in (to the palm of the hand). The acronym was designed to help clinicians identify spasticity following a stroke that might cause problems. The recommendations from the expert group are focused on clinical practice in the UK but are applicable to other countries and healthcare systems. 

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