400 Section - Clinical Validation of a Spasticity Screening Tool in Residents of a Long-Term Care Facility

Objectives : Spasticity is underrecognized among residents in long-term care, leading to functional decline and reduced quality of life. The Spasticity Screening Tool (SST), developed by Zorowitz et al. (2017), was designed to facilitate early identification of individuals with spasticity who may benefit from treatment. This study aimed to validate the SST against clinical diagnosis in a long-term care population in Southwestern Ontario.

Design: Of 375 residents approached, 348 consented to participate. Thirty-nine declined physical assessment and 16 were lost to follow-up (death, hospitalization, palliative care, or transfer). In total, 293 residents were assessed and had complete documentation. A subset of 109 residents (52 with spasticity, 57 without) was used to validate the SST. Spasticity was diagnosed by a physiatrist using physical examination and the Modified Ashworth Scale. SST scores were compared with diagnostic status using point biserial correlation, effect size estimation, and receiver operating characteristic (ROC) analysis.

Results: The cohort had a mean age of 81.6±12.2 years, with 70.0% (n=76) female. Residents with spasticity demonstrated significantly higher SST scores (mean 17.2) compared to those without (mean 7.1), yielding a large effect size (Cohen’s d = 1.08). The point biserial correlation between SST scores and spasticity diagnosis was moderate-to-strong (r = 0.48, p < .001). ROC analysis demonstrated good discriminative ability (AUC = 0.80). The optimal cutoff score (≥6 on the SST), determined by Youden’s J statistic, achieved a sensitivity of 88.5% and specificity of 59.6%.

Conclusion: The SST demonstrated good validity and clinical utility in distinguishing residents with and without spasticity in a long-term care population. Its ease of administration and strong psychometric properties support its use as a practical screening tool to enhance early recognition and management of spasticity in this setting.