Investigating muscle selection for botulinum toxin-A injections in adults with post-stroke upper limb spasticity.

Authors

  • Ian James Baguley
  • Melissa T. Nott
  • Lynne Turner-Stokes
  • Stephen De Graaff
  • Pesi Katrak
  • Paul McCrory
  • Monica de Abadal
  • Andrew Hughes

DOI:

https://doi.org/10.2340/16501977-0885

Keywords:

Muscle spasticity, botulinum toxin A, stroke, upper limb, rehabilitation, clinical reasoning.

Abstract

BACKGROUND: Limited empirical information exists regarding botulinum toxin-A injector decision-making practices for adult upper limb post-stroke spasticity. The design of most studies prevents such an assessment, as injection sites and dosage are mandated by researcher protocols. This contrasts to usual injector practices, where individualized decision-making is the standard of care. DESIGN: Secondary data analysis from an Australian randomized controlled trial of 90 adults with upper limb post-stroke spasticity where experienced clinicians followed their standard clinical injecting practice rather than a mandated injection regimen. METHODS: Clinicians were hypothesized to tailor their injection practices according to the subject's degree of spasticity and/or the type of functional gain desired. Hypothesis testing was conducted using non-parametric analysis. RESULTS: Muscle selection and botulinum toxin-A dosage were not significantly associated with spasticity severity or with patient-identified goals. Between-site differences in injection practices suggested that injector beliefs, rather than patient characteristics, were the dominant feature driving botulinum toxin-A injection strategy for post-stroke upper limb spasticity. CONCLUSION: This result looks into the "black box" of rehabilitation, revealing significant variation in injector beliefs. Findings suggest that further scientific work is required to maximize the efficacy of botulinum toxin-A injections in post-stroke upper limb spasticity management.

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Published

2011-10-17

How to Cite

Baguley, I. J., Nott, M. T., Turner-Stokes, L., De Graaff, S., Katrak, P., McCrory, P., de Abadal, M., & Hughes, A. (2011). Investigating muscle selection for botulinum toxin-A injections in adults with post-stroke upper limb spasticity. Journal of Rehabilitation Medicine, 43(11), 1032–1037. https://doi.org/10.2340/16501977-0885

Issue

Section

Original Report