CLINICAL GUIDANCE
AAPM&R consensus guidance on spasticity assessment and management
Monica Verduzco-Gutierrez MD,
Preeti Raghavan MD,
Jessica Pruente MD,
Daniel Moon MD, MS,
Cassandra M. List MD,
Joseph Edward Hornyak MD, PhD,
Fatma Gul MD, MS,
Supreet Deshpande MD,
Susan Biffl MD,
Zainab Al Lawati MD, MEd, FRCPC, FAAPMR,
Abraham Alfaro PhD, DO,
Corresponding Author
Monica Verduzco-Gutierrez MD
Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
Correspondence
Monica Verduzco-Gutierrez, Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Email: [email protected]
Search for more papers by this authorPreeti Raghavan MD
Department of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorJessica Pruente MD
Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
Search for more papers by this authorDaniel Moon MD, MS
Department of Physical Medicine and Rehabilitation, Jefferson Moss-Magee Rehabilitation Hospital, Elkins Park, Pennsylvania, USA
Search for more papers by this authorCassandra M. List MD
Brooks Rehabilitation Hospital, Jacksonville, Florida, USA
Search for more papers by this authorJoseph Edward Hornyak MD, PhD
Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
Search for more papers by this authorFatma Gul MD, MS
Department of Physical Medicine and Rehabilitation Department, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
Search for more papers by this authorSupreet Deshpande MD
Department of Pediatric Rehabilitation Medicine, Gillette Children's Hospital, St.Paul, Minnesota, USA
Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
Search for more papers by this authorSusan Biffl MD
Division Pediatric Rehabilitation Medicine Department of Orthopedic Surgery, UCSD Rady Children's Hospital, San Diego, California, USA
Search for more papers by this authorZainab Al Lawati MD, MEd, FRCPC, FAAPMR
Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
Search for more papers by this authorAbraham Alfaro PhD, DO
Rehabilitation Medicine, AtlantiCare Health Services, Inc., Federally Qualified Health Center (FQHC), Atlantic City, New Jersey, USA
Search for more papers by this authorMonica Verduzco-Gutierrez MD,
Preeti Raghavan MD,
Jessica Pruente MD,
Daniel Moon MD, MS,
Cassandra M. List MD,
Joseph Edward Hornyak MD, PhD,
Fatma Gul MD, MS,
Supreet Deshpande MD,
Susan Biffl MD,
Zainab Al Lawati MD, MEd, FRCPC, FAAPMR,
Abraham Alfaro PhD, DO,
Corresponding Author
Monica Verduzco-Gutierrez MD
Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
Correspondence
Monica Verduzco-Gutierrez, Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Email: [email protected]
Search for more papers by this authorPreeti Raghavan MD
Department of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorJessica Pruente MD
Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
Search for more papers by this authorDaniel Moon MD, MS
Department of Physical Medicine and Rehabilitation, Jefferson Moss-Magee Rehabilitation Hospital, Elkins Park, Pennsylvania, USA
Search for more papers by this authorCassandra M. List MD
Brooks Rehabilitation Hospital, Jacksonville, Florida, USA
Search for more papers by this authorJoseph Edward Hornyak MD, PhD
Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
Search for more papers by this authorFatma Gul MD, MS
Department of Physical Medicine and Rehabilitation Department, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
Search for more papers by this authorSupreet Deshpande MD
Department of Pediatric Rehabilitation Medicine, Gillette Children's Hospital, St.Paul, Minnesota, USA
Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
Search for more papers by this authorSusan Biffl MD
Division Pediatric Rehabilitation Medicine Department of Orthopedic Surgery, UCSD Rady Children's Hospital, San Diego, California, USA
Search for more papers by this authorZainab Al Lawati MD, MEd, FRCPC, FAAPMR
Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
Search for more papers by this authorAbraham Alfaro PhD, DO
Rehabilitation Medicine, AtlantiCare Health Services, Inc., Federally Qualified Health Center (FQHC), Atlantic City, New Jersey, USA
Search for more papers by this authorAbstract
Background
The American Academy of Physical Medicine and Rehabilitation (AAPM&R) conducted a comprehensive review in 2021 to identify opportunities for enhancing the care of adult and pediatric patients with spasticity. A technical expert panel (TEP) was convened to develop consensus-based practice recommendations aimed at addressing gaps in spasticity care.
Objective
To develop consensus-based practice recommendations to identify and address gaps in spasticity care.
Methods
The Spasticity TEP engaged in a 16-month virtual meeting process, focusing on formulating search terms, refining research questions, and conducting a structured evidence review. Evidence quality was assessed by the AAPM&R Evidence, Quality and Performance Committee (EQPC), and a modified Delphi process was employed to achieve consensus on recommendation statements and evidence grading. The Strength of Recommendation Taxonomy (SORT) guided the rating of individual studies and the strength of recommendations.
Results
The TEP approved five recommendations for spasticity management and five best practices for assessment and management, with one recommendation unable to be graded due to evidence limitations. Best practices were defined as widely accepted components of care, while recommendations required structured evidence reviews and grading. The consensus guidance statement represents current best practices and evidence-based treatment options, intended for use by PM&R physicians caring for patients with spasticity.
Conclusion
This consensus guidance provides clinicians with practical recommendations for spasticity assessment and management based on the best available evidence and expert opinion. Clinical judgment should be exercised, and recommendations tailored to individual patient needs, preferences, and risk profiles. The accompanying table summarizes the best practice recommendations for spasticity assessment and management, reflecting principles with little controversy in care delivery.
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