524 - Sensitivity and specificity of the Post-stroke Spasticity Monitoring Questionnaire (PSMQ) for remote monitoring of spasticity development: Interim analysis from an ongoing epidemiological study

Eligible participants are stroke survivors (18-85y) with paresis ≤2 weeks of a first-ever stroke that has occurred within ≤4 weeks. Participants complete the PSMQ at intervals up to 12-months post stroke. Participants with a PSMQ score ≥2 undergo an in-clinic confirmatory assessment; those without clinically-confirmed PSS resume remote monitoring. All enrolled participants underwent an in-clinic confirmation visit, regardless of remote PSMQ scoring. Receiver operating characteristic (ROC) curve analyses evaluated which PSMQ items were most predictive of spasticity.

Results:

Of 372 enrolled participants, 151 were included in the interim analysis. Overall, 99 participants (65.6%) have had a PSMQ score ≥2 and 69 (45.7%) had a MAS score >0. The sensitivity of the PSMQ was 81% but the specificity was 48%. ROC analyses identified that simplifying the PMSQ to just Q1 and Q2 of the PSMQ retained the predictiveness of the tool (ROC AUC of 0.69 with items 1+2 vs 0.66 with PSMQ-total score) while reducing burden of questionnaire completion.

Conclusions: Within 1 year of their stroke, 45.7% of stroke survivors with paresis developed spasticity. Results indicate the PSMQ’s usefulness for remote monitoring of PSS development, although the threshold of ≥2 may be too sensitive, leading to high false-positive rates. The study protocol has been simplified to use solely PMSQ items 1 and 2 (rating stiffness/tightness and difficulty bending/flexing the limb) for remote monitoring. Future analyses will examine the rates, timing and severity of ‘problematic’ spasticity, and the optimal timing of remote monitoring.