Getting the measure of spasticity in multiple sclerosis: The Multiple Sclerosis Spasticity Scale (MSSS-88)

Murdoch University, Perth City, Western Australia, Australia
Brain (Impact Factor: 9.2). 02/2006; 129(Pt 1):224-34. DOI: 10.1093/brain/awh675
Source: PubMed


Spasticity is most commonly defined as an inappropriate, velocity dependent, increase in muscle tonic stretch reflexes, due to the amplified reactivity of motor segments to sensory input. It forms one component of the upper motor neuron syndrome and often leads to muscle stiffness and disability. Spasticity can, therefore, be measured through electrophysiological, biomechanical and clinical evaluation, the last most commonly using the Ashworth scale. None of these techniques incorporate the patient experience of spasticity, nor how it affects people's daily lives. Consequently, we set out to construct a rating scale to quantify the perspectives of the impact of spasticity on people with multiple sclerosis. Qualitative methods (in-depth patient interviews and focus groups, expert opinion and literature review) were used to develop a conceptual framework of spasticity impact, and to generate a pool of items with the potential to convert this framework into a rating scale with multiple dimensions. This item pool was administered, in the form of a questionnaire, to a sample of people with multiple sclerosis and spasticity. Guided by Rasch analysis, we constructed and validated a rating scale for each component of the conceptual framework. Decisions regarding item selection were based on the integration and assimilation of seven specific analyses including clinical meaning, ordering of thresholds, fit statistics and differential item functioning. The qualitative phase (17 patient interviews, 3 focus groups) generated 144 potential scale items and a conceptual model with eight components addressing symptoms (muscle stiffness, pain and discomfort and muscle spasms,), physical impact (activities of daily living, walking and body movements) and psychosocial impact (emotional health, social functioning). The first postal survey was sent to 272 people with multiple sclerosis and had a response rate of 88%. Findings supported the development of scales for each component but demonstrated that five item response options were too many. The 144-item questionnaire, reformatted with four-item response options, was administered with four validating instruments to an independent sample of 259 people with multiple sclerosis (response rate 78%). From the responses, an 88-item instrument with eight subscales was developed that satisfied criteria for reliable and valid measurement. Correlations with other measures were consistent with predictions. The 88-item Multiple Sclerosis Spasticity Scale (MSSS-88) is a reliable and valid, patient-based, interval-level measure of the impact of spasticity in multiple sclerosis. It has the potential to advance outcomes measurement in clinical trials and clinical practice, and provides a new perspective in the clinical evaluation of spasticity.

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    • "The treating physician, who was aware of group allocation because she had to set up the stimulation protocol , was instructed not to talk to both the patients and assessing physicians about the stimulation procedure . Modified Ashworth Spasticity scale (MAS) (Bohannon et al., 1987), Multiple Sclerosis Spasticity Scale (MSSS-88) (Hobart et al., 2006) and Multiple sclerosis walking scale (MSWS-12) (Hobart et al., 2003) were evaluated by two neurologists who were unaware of group allocation, on the first day of treatment before the session stimulation beginning and immediately after the last stimulation session, on five day of stimulation. "
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    ABSTRACT: Purpose: To assess whether anodal transcranial direct current stimulation (tDCS) is effective in modulating lower limb spasticity in MS patients. Previously, anodal tDCS has been shown to improve motor deficits in several neurological diseases and, recently, it has been proposed as effective in decreasing spasticity after stroke. However, the effect of anodal tDCS on spasticity is not examined in MS. Methods: We performed a single-centre randomized, double-blind, sham-controlled study to investigate efficacy of anodal vs sham tDCS in 20 relapsing-remitting MS patients. Ten patients received anodal tDCS stimulation to the primary motor cortex of the more affected side, 20 minutes/day for 5 consecutive days. Ten patients received sham tDCS stimulation. Spasticity was assessed by using the modified Ashworth scale (MAS), the self-scoring MSSS-88 (Multiple Sclerosis Spasticity Scale) and Multiple Sclerosis Walking Scale (MSWS-12) at baseline and at the end of protocol stimulation. Results: No side effects were detected during either anodal tDCS or sham. In both groups, there was no significant improvement in MAS, MSSS-88 and MSWS-12 scores. Moreover the comparison between anodal tDCS and sham showed no difference. Conclusions: Five-daily sessions of anodal tDCS to the primary motor cortex does do not improve lower limb spasticity in MS patients.
    Full-text · Article · Sep 2015
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    • "Other widely used scales are the parametric NRS 0-10 spasticity scale (Farrar et al. 2008), which assesses in a reliable and valid manner, even superior to the previous Ashworth scale, the intensity of spasticity perceived by the patient, and the PSFS (Penn Spasm Frequency Scale) for quantifying the number of spasms in the affected limb during the day. The development of the MSSS-8 scale (Hobart et al. 2006) offered a new perspective in clinical evaluation of spasticity by considering the patients' experience and perception of the impact of spasticity on their daily life, which coincides with alterations of the spatio-temporal parameters of gait (Balantrapu et al. 2012). Additionally, a new measure of disability and functionality related to spasticity (Rekand disability and spasticity score) is being validated (Rekand 2010). "
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    ABSTRACT: IntroductionSpasticity is one of the most disabling and difficult-to-treat symptoms shown by patients with multiple sclerosis, who often show a suboptimal and unsatisfactory response to classic treatment and new available nonpharmacological alternatives. Due to the progressive nature of this condition, the early management should be essential to improve long-term outcomes.Methods We performed a narrative literature review of the contribution of spasticity to the burden of multiple sclerosis and the potential role of classic disease-modifying drugs.ResultsAdded to the underlying pathophysiology of spasticity, certain external factors and drugs such as interferon may exacerbate the existing condition, hence their awareness is crucial as part of an effective management of spasticity. Furthermore, the evidence for the effectiveness of glatiramer acetate in preventing spasticity in naïve patients and in those switching from interferon should not be ignored.Conclusions This literature review proposes the examination of spasticity and the influence of classic disease-modifying agents on the level of existing condition among the variables to be considered when deciding on therapy for multiple sclerosis in clinical practice.
    Full-text · Article · Jul 2015 · Brain and Behavior
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    • "The BBS was developed to measure balance among older people with impairment in balance function by assessing the performance of functional tasks.16 The BBS was found to be a valid and reliable instrument in the elderly and post-stroke.41 Psychometric properties of the BBS have also been evaluated for MS. "
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    ABSTRACT: Multiple sclerosis (MS) manifests itself in a wide range of symptoms. Physiotherapy plays an important role in the treatment of those symptoms connected with mobility. For this therapy to be at its most effective it should be based on a systematic examination that is able to describe and classify damaged clinical functions meaningfully. The purpose of this study was to develop and validate a battery of tests and composite tests that can be used to systematically evaluate clinical features of MS treatable by physiotherapy. The authors assembled a proposed battery of tests comprising known, standard, and validated assessments (low-contrast letter acuity testing; the Motricity Index; the Modified Ashworth Scale; the Berg Balance Scale; scales of postural reactions, tremor, dysdiadochokinesia, and dysmetria; the Nine-Hole Peg Test; the Timed 25-Foot Walk; and the 3-minute version of the Paced Auditory Serial Addition Test) and one test (knee hyperextension) of the authors' own. Normalization was calculated and six composite assessments were measured. Seventeen ambulatory subjects with MS were tested twice with the assessment set before undergoing physiotherapy, and 12 were also tested with the assessment set after the physiotherapy. The test-retest reliability, stability, internal consistency of composite measurements, sensitivity to changes after therapy, and correlation between measurements and the Kurtzke Expanded Disability Status Scale score were evaluated for all tests in the assessment set. A good internal consistency was confirmed for all tests in the proposed battery, and most of the tests also showed good test-retest reliability. While no significant changes occurred without treatment, significant posttreatment improvement was proved in all tests except for low-contrast letter acuity testing, where only a trend to improvement was proved. The proposed assessment set is a good tool for the evaluation of clinical features of MS treatable by physiotherapy. This battery of tests is applicable in both clinical practice and research.
    Full-text · Article · Oct 2012 · Patient Related Outcome Measures
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