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Treatment patterns of in-patient spasticity medication use after traumatic spinal cord injury: a prospective cohort study

Spinal Cord (2018) | Download Citation

Abstract

Study Design

Prospective cohort study using the Rick Hansen SCI Registry (RHSCIR) and retrospective medical chart review.

Objective

To describe treatment patterns of in-patient anti-spasticity medication use following traumatic spinal cord injury (SCI) in acute and rehabilitation hospital settings in British Columbia, Canada.

Setting

Quaternary trauma center, rehabilitation center.

Methods

Individuals with traumatic SCI between 2005 and 2014 enrolled in the Vancouver RHSCIR site (N = 917) were eligible for inclusion. Oral and injectable anti-spasticity medication use were the main outcome measures.

Results

In 769 participants, higher neurological level and injury severity were associated with in-patient anti-spasticity medication use (p < 0.001 for both). Of individuals with cervical and thoracic injuries (n = 589), 37% were prescribed anti-spasticity medication during hospital admission. Baclofen was the most commonly used first line oral therapy. Mean (SD) and median time from injury to Baclofen initiation was 70 (69) and 50 days, respectively. The probability of having initiated an in-patient anti-spasticity medication was 55% (95% CI (49, 60)) for individuals 6 months post-injury, and 71% (95% CI (62, 79)) for individuals 12 months post-injury. At community discharge, the prevalence of oral and injectable anti-spasticity medication use was 26 and 5%. Practice patterns of anti-spasticity medication use (2005–2009 vs. 2010–2014) have not changed significantly over time.

Conclusions

This is the first large prospective cohort study of in-patient anti-spasticity medication use following traumatic SCI. Results from our study inform clinicians and individuals of “real world” anti-spasticity medication use among individuals with traumatic SCI and may help guide care for this population in the community.

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Acknowledgements

We are grateful to the following individuals for their contribution: Juliet Batke and Allan Aludino of the Vancouver Spine Research Program for database management and data abstraction; Glenys MacIsaac of the Rick Hansen Institute for technical support of data management; and Darby Thompson and Rachel Lipson from Emmes Canada for statistical support and assistance with data analysis.

Funding

Dr. Kwon is the Canada Research Chair in Spinal Cord Injury.

Author contributions

KH was responsible for designing the research protocol, data collection, data interpretation, generated the reference list and was the primary author of the manuscript. ES contributed to research design, performed statistical analysis, contributed to writing the manuscript and created the tables and figure. VN provided feedback on the study design and manuscript. BK provided feedback on the study design and manuscript. PM was responsible for designing the research protocol, assisted in data interpretation and contributed to writing the manuscript.

Author information

Affiliations

  1. Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada

    • Kaila A. Holtz
    •  & Patricia B. Mills
  2. Emmes Canada, Burnaby, BC, Canada

    • Elena Szefer
  3. Rick Hansen Institute, Vancouver British Columbia, Vancouver, BC, Canada

    • Vanessa K Noonan
  4. ICORD (International Collaboration on Repair Discoveries), University of British Columbia, Vancouver, BC, Canada

    • Brian K. Kwon
    •  & Patricia B. Mills
  5. Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada

    • Brian K. Kwon
  6. Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada

    • Patricia B. Mills

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Conflict of interest

Ms. Szefer is an employee of Emmes Canada. Dr. Noonan is an employee of the Rick Hansen Institute. The remaining authors declares no conflict of interest.

Corresponding author

Correspondence to Patricia B. Mills.

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DOI

https://doi.org/10.1038/s41393-018-0165-0