Spasticity Health Literacy Among Canadian Family Physicians.

One of the consequences of upper motor neuron disease is the development of spasticity, classically defined as a “velocitydependent increase in muscle tone and hyper-excitability of the stretch reflex.” Although alternative definitions have been recently proposed that define spasticity as a “disordered sensorimotor control,” in this study, we focused on the classic definition underlying velocity dependence and hyperexcitability of stretch reflexes that is accepted and included in standard medical textbooks. Patients presenting with spasticity must first be assessed in a comprehensive manner to determine whether treatment is required or appropriate. The presence of spasticity may improve functionality by enabling standing, walking, and transferring. When spasticity is considered disabling and involves severe functional problems, management is essential to prevent further deterioration in function. If not managed in a timely manner, spasticity can lead to diminished activity and eventually can result in contractures. There are several pharmacological approaches based on the presentation of spasticity. Oral medications such as baclofen and tizanidine have been proven to be effective for spasticity that is seen in multiple muscles and limbs (generalized spasticity). Although effective, oral medications have known dose-related side effects such as drowsiness, headache, nausea, and constipation. As a result, patients are often taken off these medications before a clinical improvement in their spasticity can be observed. Generalized spasticity that has proven unresponsive to oral baclofen or tizanidine is best treated with an intrathecal baclofen pump. Intramuscular injections of botulinum toxin have been repeatedly demonstrated in the literature to be effective for treating focal spasticity such as seen in the wrist and finger flexor muscle groups. This medication also bypasses the side effects described previously that are associated with systemic therapies. The decrease in muscle tone achieved with botulinum toxin can last for three to four months, and may be prolonged for even longer with the adjunctive use of physical therapy programs. The outcome of disabling spasticity is often a severe limitation of patients’ activities of daily living, which can increase the burden on caregivers. This results in significant financial and social burdens for both the patient and the province in which the patient resides. Chronic spasticity can lead to a state of prolonged immobility, resulting in contractures, which further limit patient independence and add to caregiver requirements. It is for these reasons that appropriate medical care is paramount. As is the case with most other chronic conditions, spasticity patients usually present to their family physicians in the initial stages of upper motor neuron syndrome. Because spasticity is the result of a variety of neurological and traumatic conditions, it is concerning that a previous study demonstrated limited knowledge in the recognition and treatment of spasticity among Ontario family physicians. Without this understanding, family physicians are not likely to appropriately refer and, therefore, without intention, deny the benefit of effective therapeutic intervention to the impaired patient. Given the importance and central role of the family physician in patient care, it is necessary to consider what factors may influence the physician’s level of knowledge. The purpose of this study was to assess spasticity-related literacy among family physicians across Canada and whether the literacy was related to gender, Canadian versus international medical training, and years of experience among family physicians.