<p>A Simple Bedside Screening Tool for Spasticity Referral</p>

• DOI: 10.2147/cia.s248602
• Publication Date: 2020-05-12T23:30:35Z
• Authors: Mallory L Hacker; Shelby Ploucher; Aaditi G Naik; Maxim Turchan; Jacqueline C Meys...; Kelly Harper; Peter Hedera; Claude J Pirtle; Kassandra Stubble...; David Charles
• Keywords: Male; primary care; 03 medical and health sciences; 0302 clinical medicine; Humans; Mass Screening; neurological disease; Diagnostic Errors; Referral and Consultation; Original Research; Aged; screening; RC952-954.6; spasticity; Long-Term Care; Nursing Homes; 3. Good health; Cross-Sectional Studies; Geriatrics; Muscle Spasticity; Point-of-Care Testing; Clinical Interventions in Aging; long-term care; Female

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.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.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).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.