Abstract WP317: Post-Stroke Spasticity: Gaps in Documentation, Treatment, and Recovery

Spasticity is common after stroke, often causing pain, soft tissue stiffness, joint contracture, abnormal limb posture, decreased quality of life, increased treatment costs, and increased caregiver burden. It is frequently under-documented and inconsistently described, limiting understanding of its prevalence, severity, and management. Evaluating current practices may inform clinical decisions and enhance rehabilitation strategies. A retrospective observational study was conducted using the target hospital’s Observational Acute Stroke and Thrombectomy Registry, including patients with ischemic or hemorrhagic stroke admitted from 2017 to 2024. Patients were stratified by clinical documentation of spasticity (spasticity, increased tone, hyperreflexia, or related terms). The primary aim was to quantify spasticity prevalence and management. Demographics, stroke severity (LOS, NIHSS) and functional outcomes (mRS, treatment adherence, clinical progression) were compared using appropriate statistical tests. Spasticity was observed in 34 out of 151 patients (22.5%), most often documented in Rehab/PM&R (n=12, 35.3%), Neurology (n=10, 29.4%), and PT/OT (n=6, 17.6%) notes, with rare mentions in other specialties. Treatments included PT/OT (n=14, 41.2%), oral baclofen (n=11, 32.4%), and botulinum toxin injections (n=6, 17.6%), with adherence rates of 92.9%, 81.8%, and 50% respectively. One patient (2.9%) used NMES; no surgical interventions or intrathecal baclofen pumps were used. Patients with spasticity had higher baseline NIHSS scores (11.5 [5-18] vs 5 [1-14.75], p=0.009) and a trend towards longer LOS (13.7 vs 6.6 days, p=0.072). Pre-event mRS was similar (0 [0-2] vs 0 [0-2], p=0.38), but spasticity patients had worse discharge (4 [4-5] vs 3 [2-4], p<0.001) and 90-day post-discharge mRS (4 [3-5] vs 2 [1-4], p<0.001). Patients receiving any treatment were younger (65 vs 75 years, p=0.025) and had delayed spasticity onset (107.3 vs 3.2 days, p=0.02). Early spasticity onset and fewer treatments were linked to worse clinical progression (p=0.017; p=0.026). Race was associated with spasticity (p=0.034), with higher rates in African Americans; sex, age, and ethnicity did not differ. This preliminary analysis showed functional differences in post-stroke patients with spasticity and highlights variations in documentation, timing, and treatment practices. Expanding to a larger cohort will clarify these patterns and inform strategies to improve long-term recovery.