Outcomes of ambulatory rehabilitation programmes following botulinum toxin for spasticity in adults with stroke.

Authors

  • Marina Demetrios
  • Alexandra Gorelik
  • Julie Louie
  • Caroline Brand
  • Ian J Baguley
  • Fary Khan

DOI:

https://doi.org/10.2340/16501977-1842

Keywords:

botulinum toxin, muscle spasticity, stroke, rehabilitation.

Abstract

OBJECTIVE: To examine the benefits of high intensity ambulatory rehabilitation programmes over usual care following botulinum toxin A (BoNT-A) for post-stroke spasticity in Australian adults. DESIGN: Prospective single centre, controlled clinical trial. PARTICIPANTS: Fifty-nine adults, median 61 years old and 2.5 years following stroke. METHODS: PARTICIPANTS were dichotomised into high intensity ambulatory rehabilitation programmes (≥ 3 × 1-h weekly sessions for approximately 10 weeks) or usual care programmes (≤ 2 × 1-h weekly sessions) following BoNT-A injections for spasticity. A blinded assessor completed outcomes at 0 (baseline), 6, 12 and 24 weeks. Primary endpoints: proportion of participants achieving ≥ 50% of their goals (using Goal Attainment Scaling: GAS) and GAS T-score change at 12 weeks. SECONDARY OUTCOMES: Modified Ashworth Scale (MAS), participant satisfaction, activity/participation measures and caregiver burden. RESULTS: Both groups showed significant improvement in goal attainment and participant satisfaction up to 24 weeks, with no overall between-group significant differences. There was, however, a statistical trend (p = 0.052) for participants to achieve more upper limb goals in the high intensity therapy group. GAS and satisfaction benefits persisted beyond the duration of spasticity reduction as measured by MAS. CONCLUSIONS: While patient-centred outcomes following BoNT-A injections for post-stroke spasticity were not influenced by intensity of ambulatory rehabilitation programmes, there was a trend for high intensity therapy to be associated with greater upper limb goal attainment. This suggests that the effects of more intensive therapy may be a modifier of the 'black box' of rehabilitation

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Published

2014-06-11

How to Cite

Demetrios, M., Gorelik, A., Louie, J., Brand, C., Baguley, I. J., & Khan, F. (2014). Outcomes of ambulatory rehabilitation programmes following botulinum toxin for spasticity in adults with stroke. Journal of Rehabilitation Medicine, 46(8), 730–737. https://doi.org/10.2340/16501977-1842

Issue

Section

Original Report