Long-term effect of additional rehabilitation following botulinum toxin-A on upper limb activity in chronic stroke: the InTENSE randomised trial

BMC Neurology

Mithu Palit¹  Senen Gonzalez²  Maria Crotty³  Julie Ratcliffe³  Natasha A. Lannin⁴  Emma Schneider⁴  John Olver⁵  Ian D. Cameron⁶  Steven Faux⁷  Coralie English⁸  Louise Ada⁹ 

[1]Alfred Health

[2]Austin Health

[3]College of Nursing and Health Sciences, Flinders University

[4]Department of Neurosciences, Central Clinical School, Monash University

[5]Epworth Monash Rehabilitation Medicine Research Unit, Monash University

[6]John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District

[7]Sacred Heart Rehabilitation Unit, St Vincent’s Hospital

[8]School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle

[9]The University of Sydney

关键词: Botulinum toxin type A;    Stroke;    Spasticity;    Wrist;    Rehabilitation;    Neuroscience;   

DOI  :  10.1186/s12883-022-02672-8

来源: DOAJ

【 摘 要 】

Abstract Background It is common for people with persistent spasticity due to a stroke to receive an injection of botulinum toxin-A in the upper limb, however post-injection intervention varies. Aim To determine the long-term effect of additional upper limb rehabilitation following botulinum toxin-A in chronic stroke. Method An analysis of long-term outcomes from national, multicenter, Phase III randomised trial with concealed allocation, blinded measurement and intention-to-treat analysis was carried out. Participants were 140 stroke survivors who were scheduled to receive botulinum toxin-A in any muscle(s) that cross the wrist because of moderate to severe spasticity after a stroke greater than 3 months ago, who had completed formal rehabilitation and had no significant cognitive impairment. Experimental group received botulinum toxin-A plus 3 months of evidence-based movement training while the control group received botulinum toxin-A plus a handout of exercises. Primary outcomes were goal attainment (Goal Attainment Scale) and upper limb activity (Box and Block Test) at 12 months (ie, 9 months beyond the intervention). Secondary outcomes were spasticity, range of motion, strength, pain, burden of care, and health-related quality of life. Results By 12 months, the experimental group scored the same as the control group on the Goal Attainment Scale (MD 0 T-score, 95% CI -5 to 5) and on the Box and Block Test (MD 0.01 blocks/s, 95% CI -0.01 to 0.03). There were no differences between groups on any secondary outcome. Conclusion Additional intensive upper limb rehabilitation following botulinum toxin-A in chronic stroke survivors with a disabled upper limb is not more effective in the long-term. Trial Registration ACTRN12615000616572 (12/06/2015). 

【 授权许可】

Unknown