Impact of a Multidisciplinary Lower Limb Spasticity Clinic on Gait Speed,Dynamic Balance,Quality of Life,and Service Outcomes in a Neurological Outpatient Setting;a Pragmatic pre-Post Observational Study

Abstract

Background

Lower limb spasticity (LLS), as part of the upper motor neuron syndrome, can adversely affect function, gait, and quality of life (QOL). A multidisciplinary team (MDT) approach is recommended however, the effects of a coordinated MDT clinic on LLS and ambulation in a mixed neurological population has not been investigated.

Objectives

This study evaluated: i) clinical and service outcomes of a pragmatic outpatient MDT spasticity service; and ii) patient service satisfaction.

Methods

In this prospective pre-post observational study, 37 participants from a mixed neurological population with LLS received an individualised treatment protocol. Gait speed (10-metre walk test), dynamic balance (Timed-Up and Go), Quality of Life (AQoL-8D), and spasticity-related lower limb function (Leg Activity Measure) were assessed at admission and discharge. Patient satisfaction surveys were completed. Wait times for orthotics were monitored.

Results

Significant differences were observed in gait speed (median (IQR) 0.30 (0.16–0.39) seconds, p ≤ .001), dynamic balance (median (IQR) 3.87 (2.02–8.59) seconds, p ≤ .001), and lower limb function (median (IQR) 9.00 (−4.00–26.00), p = 0.006) following intervention. QOL improved (median (IQR) −0.70 (−8.5–2.10), however this change did not reach statistical significance (p = 0.206). Over 85% of participants reported service satisfaction. Orthotic wait times reduced, with 64.7% assessed and 52.9% fitted within two weeks of referral.

Conclusion

An individualised LLS treatment protocol delivered by a collaborative MDT can improve gait speed, dynamic balance, and lower limb function in a mixed neurological population, while also reducing orthotic wait times. Further research is recommended to explore potential QOL interventions for individuals with LLS.