Spasticity Predictive Factors of Inpatients with Stroke During Hospitalization in a Rehabilitation Center
Abstract:
Background: To investigate the incidence, onset time, and predictive factors of early regional spasticity among first time stroke patients hospitalized for rehabilitation.
Methods:”A total of 342 consecutive stroke inpatients were admitted to the Attica Rehabilitation Center between July 2023 and July 2024. All patients experienced their first-ever stroke 3–10 days prior to admission. A rehabilitation physician assessed muscle tone changes on the hemiplegic side weekly during hospitalization. Eighty-nine of the 342 patients (34.2%) developed spasticity, of whom 71 met inclusion criteria (hospitalization 7–90 days post-stroke; mean 17.8 days).
Results: Among the 71 patients, 41 (57.7%) were men and 30 (42.3%) women; 57 (80.3%) had ischemic and 14 (19.7%) hemorrhagic strokes. Left hemiplegia was present in 34 (47.9%) and right hemiplegia in 37 (52.1%). Age distribution: >80 years (22.8%), 71–80 (30.5%), 61–70 (25.7%), 51–60 (11.4%), and 41–50 (4.4%). Comorbidities were observed in 24.3% of patients, 55.7% were smokers, and 13.0% were obese. The admission Barthel Index ranged from 2 to 24/100 (mean 9). Treatment included Botulinum Toxin type A injections in 38 patients (53.5%) and oral antispastic medication in 26 (36.6%). Spasticity incidence was 34.2% (Modified Ashworth Scale ≥1 and Brunn strom stage 2. Sex, hemiplegic side, and age were not associated with spasticity onset. Lower Barthel Index, ischemic stroke, smoking, and obesity were identified as predictive factors.
Conclusion: Approximately one-third of first-stroke patients developed early spasticity during rehabilitation. Func tional dependence (low Barthel Index), ischemic stroke etiology, smoking, and obesity were significant predictors. Early identification of these factors may enable timely interventions—such as early Botulinum Toxin A administra tion—potentially improving long-term outcomes and rehabilitation cost-effectiveness.
