Treatment patterns of in-patient spasticity medication use after traumatic spinal cord injury: a prospective cohort study

• Published in: Spinal cord Vol. 56; no. 12; pp. 1176 - 1183
• Main Authors: Holtz, Kaila A., Szefer, Elena, Noonan, Vanessa K, Kwon, Brian K., Mills, Patricia B.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-12-2018; Nature Publishing Group
• Subjects: 692/308/409; 692/699/375/1824; Adolescent; Adult; Aged; Anatomy; Baclofen; Biomedical and Life Sciences; Biomedicine; Cohort analysis; Communities; Drugs; Female; Health risk assessment; Human Physiology; Humans; Injuries; Male; Middle Aged; Muscle Spasticity - drug therapy; Muscle Spasticity - epidemiology; Muscle Spasticity - etiology; Neurochemistry; Neuromuscular Agents - therapeutic use; Neuropsychology; Neurosciences; Patients; Practice Patterns, Physicians' - trends; Prevalence; Prospective Studies; Rehabilitation; Retrospective Studies; Spasticity; Spinal cord injuries; Spinal Cord Injuries - complications; Spinal Cord Injuries - epidemiology; Spinal Cord Injuries - rehabilitation; Thorax; Trauma; Young Adult
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/s41393-018-0165-0

Study Design
Prospective cohort study using the Rick Hansen SCI Registry (RHSCIR) and retrospective medical chart review.
Objective
To describe treatment patterns of in-patient anti-spasticity medication use following traumatic spinal cord injury (SCI) in acute and rehabilitation hospital settings in British Columbia, Canada.
Setting
Quaternary trauma center, rehabilitation center.
Methods
Individuals with traumatic SCI between 2005 and 2014 enrolled in the Vancouver RHSCIR site (
N
 = 917) were eligible for inclusion. Oral and injectable anti-spasticity medication use were the main outcome measures.
Results
In 769 participants, higher neurological level and injury severity were associated with in-patient anti-spasticity medication use (
p
 < 0.001 for both). Of individuals with cervical and thoracic injuries (
n
 = 589), 37% were prescribed anti-spasticity medication during hospital admission. Baclofen was the most commonly used first line oral therapy. Mean (SD) and median time from injury to Baclofen initiation was 70 (69) and 50 days, respectively. The probability of having initiated an in-patient anti-spasticity medication was 55% (95% CI (49, 60)) for individuals 6 months post-injury, and 71% (95% CI (62, 79)) for individuals 12 months post-injury. At community discharge, the prevalence of oral and injectable anti-spasticity medication use was 26 and 5%. Practice patterns of anti-spasticity medication use (2005–2009 vs. 2010–2014) have not changed significantly over time.
Conclusions
This is the first large prospective cohort study of in-patient anti-spasticity medication use following traumatic SCI. Results from our study inform clinicians and individuals of “real world” anti-spasticity medication use among individuals with traumatic SCI and may help guide care for this population in the community.