1341 - Primary Results of the Initial Validation of the Spastic Movement Disorder Decision Tree – I-REFER

Nurses and therapists play an important role in the management of post-stroke patients (PSP) but validated tools to recognize evolving complications such as spasticity are scarce. The Spastic Movement Disorder Decision Tree (SMD-DT) assesses muscle tone, control of voluntary movements and stretch-induced pain in the upper limb, guiding healthcare providers’ referral decision to a specialist for further spasticity management including botulinum neurotoxin injections. The results of the SMD-DT validation (I-REFER) are presented.

Design:

I-REFER is a cross-sectional validation and inter-rater reliability study to explore the degree of agreement between nurses and physicians experienced in spasticity management (the ‘gold standard’) assessing PSP and determining the need for specialist referral using the SMD-DT (dichotomous endpoint: referral yes/no). The secondary objective is to examine the validity of the SMD-DT used by physio- and occupational therapists, compared to the same ‘gold standard’.

Results:

69 PSP in early post-acute to chronic phase were included and described previously ^[2]. The level of agreement is good (0.71) at 85.5% rate of agreement for nurses and very good (0.80) at 89.9% for therapists compared to ‘gold standard’. Sensitivity and specificity are 0.85/0.87 for nurses and 0.87/0.93 for therapists. Positive predictive value and negative predictive value are 0.89/0.81 for nurses and 0.94/0.85 for therapists. All Kappa values are highly significant (p < 0.001).

Conclusions:

Nurses and therapists demonstrated good to very good agreement with ‘gold standard’ evaluations when using the SMD-DT with favorable comparative parameters. The SMD-DT is a promising tool for spasticity recognition and treatment referral decisions.