ArticleFrontiers in neurology
Early recognition of post-stroke spasticity: the I-REFER study.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06381999 (Initial Assessment of the Validity and Inter-Rater Reliability for Early Recognition of Spasticity Using the Decision Tree Tool), which is not on this map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Initial Assessment of the Validity and Inter-Rater Reliability for Early Recognition of Spasticity Using the Decision Tree Tool
Who cites it
1 citing paper in PubMed.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Effective post-stroke spasticity (PSS) management relies on early recognition and treatment, but access to specialist physicians is limited and PSS remains underdiagnosed and undertreated. Empowering non-specialist nurses and therapists to identify potential harmful PSS may expedite appropriate referral. We assessed validity and inter-rater reliability (IRR) of the spastic movement disorders decision tree for upper extremity spasticity by comparing referral decisions made by nurses and therapists to those made by specialist physicians (https://clinicaltrials.gov/study/NCT06381999). Methods: The decision tree evaluates three cardinal symptoms of PSS at the elbow, wrist, and fingers using simplified versions of standard scales. Nurses and physio-/occupational therapists used the decision tree to rate each symptom as "no/minimal," "moderate," or "severe," resulting in a dichotomous outcome of referral/no-referral to a specialist. Referral decisions ( Results: IRR was high between nurses and physicians on the need for specialist referral, overall (85.5%) and at the elbow (88.4%), wrist (85.5%), and fingers (84.1%), with 84.6% sensitivity (to correctly identify patients requiring specialist referral) and 86.7% specificity (to identify those not requiring specialist referral). Positive and negative predictive values were also high overall (89.2 and 81.3%, respectively) and at all (movement) segments. Findings were similar for therapists versus physicians. Sensitivity analyses based on a categorical endpoint (low risk for PSS, assess botulinum toxin type A [BoNT-A] indication, indication for BoNT-A) showed similar trends, although IRR versus physicians was lower for both nurses and therapists compared with dichotomous results. Conclusion: This decision tree for spasticity in the upper extremities showed high validity and reliability for effectively helping nurses and therapists recognize potential PSS and initiate specialist referral for timely diagnosis and potential BoNT-A treatment. It is recommended that this tool be introduced into standard clinical practice and its potential for broader use in community settings be examined.
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