ABSTRACT NUMBER: ESOC2026A2423 EVALUATING RISK FACTORS FOR SPASTICITY AFTER STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and aims Post-stroke spasticity (PSS) is a common complication that adversely affects functional recovery and quality of life. However, predictors of PSS remain inconsistently reported. This study aimed to identify demographic, clinical, and stroke-related factors associated with PSS to support early risk stratification and targeted rehabilitation. Methods A systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library was conducted from inception to 20 March 2024. Observational studies reporting factors associated with PSS were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Results Sixteen observational studies were included. Most demographic variables, including age, sex, smoking, and diabetes, were not associated with PSS. Hypertension was modestly associated with increased risk (OR 1.46, 95% CI 1.12–1.89). Stroke-related characteristics were stronger predictors, with haemorrhagic stroke (OR 1.97, 95% CI 1.41–2.75) and anterior circulation stroke (OR 1.67, 95% CI 1.12–2.48) significantly increasing the risk of PSS. Markers of initial clinical severity were consistently associated with PSS, including moderate-to-severe early spasticity (OR 3.98, 95% CI 2.24–7.08), sensory impairment (OR 2.13, 95% CI 1.14–3.95), lower modified Barthel Index scores (OR 0.95, 95% CI 0.94–0.97), and reduced upper extremity motricity index (OR 0.97, 95% CI 0.96–0.99). Conclusions Stroke characteristics and early clinical severity are key predictors of PSS. Early identification of high-risk individuals may enable timely interventions to reduce long-term disability. Conflict of interest Nothing to disclose