Toning it down: selecting outcome measures for spasticity management using a modified Delphi approach.

Abstract

To identify a set of clinically useful outcome measures for assessment of adults receiving treatment for spasticity. A modified Delphi process was conducted. In round 1, key areas of spasticity assessment and associated outcome measures were identified. In round 2, participants were presented with reviews of eligible outcome measures and were asked to select the tool they believed to be the "best" in each area. Consensus was achieved if there was at least 70% agreement among participants. In round 3, participants rated measures based on feasibility, ability to capture change, and usefulness of information gained for areas where consensus was not achieved in round 2. The Modified Delphi process was conducted online using survey software. Clinicians (N=32) from centers across Canada participated in this study. Not applicable. Not applicable. Of 51 tools identified initially, 8 were selected. Tools related to body structure and function included the visual analog scale, manual muscle testing, Penn Spasm Frequency Scale, and goniometry. Activity level measures included the Berg Balance Scale, Goal Attainment Scaling (GAS), and the FIM. The Modified Caregiver Strain Index was selected for the assessment of caregiver burden, while GAS was selected for participation level outcomes. A standardized set of outcome measures will assist with better documentation and standardization of assessment practices of clinicians who manage spasticity.