Clinical Trial| Volume 5, P34-39, January 2016

Spasticity in multiple sclerosis: Associations with impairments and overall quality of life

Published:October 21, 2015DOI:


      • Spasticity affects up to 85% of patients with multiple sclerosis.
      • After adjusting for confounders spasticity was found to be an independent determinant of worse quality of life in multiple sclerosis.
      • There is a strong association between spasticity and fatigue, depression, anxiety, pain and bladder problems.
      • Effective pharmacological and non-pharmacological treatments of spasticity are needed to improve the quality of life of patients with multiple sclerosis.



      • (1)
        To determine the association between spasticity and quality of life (QOL) in multiple sclerosis (MS).
      • (2)
        To investigate the associations between spasticity and impairments of function and activity limitations.


      Cross-sectional survey.


      A convenience sample of people with MS routinely attending an appointment with their local MS service.


      701 patients with clinically definite MS.

      Main outcome measures

      Demographic details were obtained and patients completed a battery of measures including spasticity (Multiple Sclerosis Spasticity Scale – 88), fatigue (Neurological Fatigue Index – MS), urinary dysfunction (Qualiveen-SF), pain (Neuropathic Pain Scale), mood disorder (Hospital Anxiety and Depression Scale), disability (World Health Organisation Disability Assessment Schedule) and QOL (Leeds Multiple Sclerosis QOL Scale).


      85.7% of patients reported spasticity. Patients with higher levels of spasticity were more likely to be disabled, suffer from depression and anxiety, have higher levels of fatigue and report more pain and bladder problems (p<0.01). Spasticity remained as a significant direct effect upon QOL in a multivariate model adjusted for other impairments, activity limitation and depression.


      There is a strong association between spasticity and fatigue, depression, anxiety, pain and bladder problems. The retention of a significant direct relationship with QOL in a multivariate model emphasises its influence upon the everyday lives of people with MS.


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        • Amato M.P.
        • Ponziani G.
        • Rossi F.
        • Liedl C.L.
        • Stefanile C.
        • Rossi L.
        Quality of life in multiple sclerosis: the impact of depression, fatigue and disability.
        Mult. Scler. 2001; 7: 340-344
        • Arroyo R.
        • Vila C.
        • Clissold S.
        Retrospective observational study of the management of multiple sclerosis patients with resistant spasticity in Spain: the ‘5E’ study.
        Expert. Rev. Pharmacoecon. Outcomes Res. 2011; 11: 205-213
        • Arroyo R.
        • Massana M.
        • Vila C.
        Correlation between spasticity and quality of life in patients with multiple sclerosis: the CANDLE study.
        Int. J. Neurosci. 2013; 123: 850-858
        • Barnes M.P.
        • Kent R.M.
        • Semlyen J.K.
        • McMullen K.M.
        Spasticity in multiple sclerosis.
        Neurorehabil. Neural Repair. 2003; 17: 66-70
        • Berger T.
        Multiple sclerosis spasticity daily management: retrospective data from Europe.
        Expert. Rev. Nneurother. 2013; 13: 3-7
        • Bhimani R.H.
        • McAlpine C.P.
        • Henly S.J.
        Understanding spasticity from patients' perspectives over time.
        J. Adv. Nurs. 2012; 68: 2504-2514
        • Bonniaud V.
        • Bryant D.
        • Parratte B.
        • Guyatt G.
        Development and validation of the short form of a urinary quality of life questionnaire: SF-Qualiveen.
        J. Urol. 2008; 180: 2592-2598
        • Ferrans C.E.
        • Zerwic J.J.
        • Wilbur J.E.
        • Larson J.L.
        Conceptual model of health-related quality of life.
        J. Nurs. scholarsh. Off. Publ. Sigma Theta Tau Int. Honor Soc. Nurs./ Sigma Theta Tau. 2005; 37: 336-342
        • Flachenecker P.
        • Henze T.
        • Zettl U.K.
        Spasticity in patients with multiple sclerosis-clinical characteristics, treatment and quality of life.
        Acta Neurol. Scand. 2014; 129: 154-162
        • Ford H.L.
        • Gerry E.
        • Tennant A.
        • Whalley D.
        • Haigh R.
        • Johnson M.H.
        Developing a disease-specific quality of life measure for people with multiple sclerosis.
        Clin. Rehabil. 2001; 15: 247-258
        • Galer B.S.
        • Jensen M.P.
        Development and preliminary validation of a pain measure specific to neuropathic pain: the neuropathic pain scale.
        Neurology. 1997; 48: 332-338
        • Goksel Karatepe A.
        • Kaya T.
        • Gunaydn R.
        • Demirhan A.
        • Ce P.
        • Gedizlioglu M.
        Quality of life in patients with multiple sclerosis: the impact of depression, fatigue, and disability.
        Int. J. Rehabil. Res. Int. Z. Rehabil. Rev. Int. Rech. Readapt. 2011; 34: 290-298
        • Hemmett L.
        • Holmes J.
        • Barnes M.
        • Russell N.
        What drives quality of life in multiple sclerosis?.
        QJM: Mon. J. Assoc. Phys. 2004; 97: 671-676
        • Hobart J.C.
        • Riazi A.
        • Thompson A.J.
        • Styles I.M.
        • Ingram W.
        • Vickery P.J.
        • et al.
        Getting the measure of spasticity in multiple sclerosis: the multiple sclerosis spasticity scale (MSSS-88).
        Brain: J. Neurol. 2006; 129: 224-234
        • Honarmand K.
        • Feinstein A.
        Validation of the Hospital Anxiety and Depression Scale for use with multiple sclerosis patients.
        Mult. Scler. 2009; 15: 1518-1524
        • Janardhan V.
        • Bakshi R.
        Quality of life in patients with multiple sclerosis: the impact of fatigue and depression.
        J. Neurol. Sci. 2002; 205: 51-58
        • Lobentanz I.S.
        • Asenbaum S.
        • Vass K.
        • Sauter C.
        • Klosch G.
        • Kollegger H.
        • et al.
        Factors influencing quality of life in multiple sclerosis patients: disability, depressive mood, fatigue and sleep quality.
        Acta Neurol. Scand. 2004; 110: 6-13
        • Mills R.J.
        • Young C.A.
        • Pallant J.F.
        • Tennant A.
        Development of a patient reported outcome scale for fatigue in multiple sclerosis: the neurological fatigue index (NFI-MS).
        Health Qual. Life Outcomes. 2010; 8: 22
        • Morley A.
        • Tod A.
        • Cramp M.
        • Mawson S.
        The meaning of spasticity to people with multiple sclerosis: what can health professionals learn?.
        Disabil. Rehabil. 2013; 35: 1284-1292
        • Nicolson P.
        • Anderson P.
        The psychosocial impact of spasticityrelated problems for people with multiple sclerosis: a focus group study.
        J. Health Psychol. 2001; 6: 551-567
      1. Oreja-Guevara, C., Gonzalez, D., Vila, C., de Sola, S. 2011. Multiple sclerosis spasticity in Spain: the 6E patients' survey. In: Proceedings of the 5th Joint triennial congress of the European and Americas Committees for Treatment and Research in Multiple Sclerosis Amsterdam, The Netherlands.

        • Paisley S.
        • Beard S.
        • Hunn A.
        • Wight J.
        Clinical effectiveness of oral treatments for spasticity in multiple sclerosis: a systematic review.
        Mult. Scler. 2002; 8: 319-329
        • Rizzo M.A.
        • Hadjimichael O.C.
        • Preiningerova J.
        • Vollmer T.L.
        Prevalence and treatment of spasticity reported by multiple sclerosis patients.
        Mult. Scler. 2004; 10: 589-595
        • Rog D.J.
        • Nurmikko T.J.
        • Friede T.
        • Young C.A.
        Validation and reliability of the Neuropathic Pain Scale (NPS) in multiple sclerosis.
        Clin. J. Pain. 2007; 23: 473-481
        • Schipper H.
        • Clinch J.J.
        Olweny CLM. Quality of life studies:these studies: definitions and conceptual issues.
        in: Spiler B. Quality of Life and Pharmacoeconomics in Clinical Trials. Lippincott-Raven, Philadelphia (PA)1996: 11-23
      2. Shakespeare, D.T., Boggild, M., Young, C., 2003. Anti-spasticity agents for multiple sclerosis. The Cochrane Database of Systematic Reviews (4) Cd001332

        • Skold C.
        Spasticity in spinal cord injury: self- and clinically rated intrinsic fluctuations and intervention-induced changes.
        Arch. Phys. Med. Rehabil. 2000; 81: 144-149
        • Skold C.
        • Levi R.
        • Seiger A.
        Spasticity after traumatic spinal cord injury: nature, severity, and location.
        Arch. Phys. Med. Rehabil. 1999; 80: 1548-1557
        • Smith K.W.
        • Avis N.E.
        • Assmann S.F.
        Distinguishing between quality of life and health status in quality of life research: a meta-analysis.
        Qual. Life Res. 1999; 8: 447-459
        • Stevenson V.L.
        Rehabilitation in practice: spasticity management.
        Clin. Rehabil. 2010; 24: 293-304
        • Svensson J.
        • Borg S.
        • Nilsson P.
        Costs and quality of life in multiple sclerosis patients with spasticity.
        Acta Neurol. Scand. 2014; 129: 13-20
        • Thompson A.J.
        • Jarrett L.
        • Lockley L.
        • Marsden J.
        • Stevenson V.L.
        Clinical management of spasticity.
        J. Neurol. Neurosurg. Psychiatry. 2005; 76: 459-463
      3. Üstün, T., 2010. World Health Organization disability assessment schedule II (WHO DAS II): development, psychometric testing and applications. Bulletin of the World Health Organization.

        • Veauthier C.
        • Paul F.
        Sleep disorders in multiple sclerosis and their relationship to fatigue.
        Sleep Med. 2014; 15: 5-14
        • Veauthier C.
        • Gaede G.
        • Radbruch H.
        • Wernecke K.D.
        • Paul F.
        Sleep disorders reduce health-related quality of life in multiple sclerosis (nottingham health profile data in patients with multiple sclerosis).
        Int. J. Mol. Sci. 2015; 16: 16514-16528
        • WHO
        The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization.
        Soc. Sci. Med. (1982). 1995; 41: 1403-1409
        • Wu N.
        • Minden S.L.
        • Hoaglin D.C.
        • Hadden L.
        • Frankel D.
        Quality of life in people with multiple sclerosis: data from the sonya slifka longitudinal multiple sclerosis study.
        J. Health Hum. Serv. Adm. 2007; 30: 233-267
        • Zigmond A.S.
        • Snaith R.P.
        The hospital anxiety and depression scale.
        Acta Psychiatr. Scand. 1983; 67: 361-370