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Can the early use of botulinum toxin in post stroke spasticity reduce contracture development? A randomised controlled trial.

Lindsay, C., Ispoglou, S., Helliwell, B., Hicklin, D., Sturman, S. and Pandyan, A., 2020. Can the early use of botulinum toxin in post stroke spasticity reduce contracture development? A randomised controlled trial. Clinical Rehabilitation, 35 (3), 399 -409.

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DOI: 10.1177/0269215520963855

Abstract

OBJECTIVE: Does early treatment of spasticity with botulinum-toxin (BoNTA), in (hyper)acute stroke patients without arm-function, reduce contractures and improve function. DESIGN: Randomised placebo-controlled-trial. SETTING: Specialised stroke-unit. PARTICIPANTS & INTERVENTION: Patients with an Action Research Arm Test (ARAT) grasp-score⩽2 who developed spasticity within six-weeks of a first stroke were randomised to receive injections of: 0.9%sodium-chloride solution (placebo) or onabotulinumtoxin-A (treatment). OUTCOME-MEASURES: Spasticity, contractures, splint use and arm function (ARAT) were taken at baseline, 12-weeks post-injection and six-months after stroke. Additionally, spasticity and contractures were measured at weeks-two, four and six post-injection. RESULTS: Ninety three patients were randomised. Mean time to intervention was 18-days (standard deviation = 9.3). Spasticity was lower in the treatment group with difference being significant between week-2 to 12 (elbow) and week-2 to 6 (wrist). Mean-difference (MD) varied between -8.5(95% CI -17 to 0) to -9.4(95% CI -14 to -5) µV.Contracture formation was slower in the treatment group. Passive range of motion was higher in the treatment group and was significant at week-12 (elbow MD6.6 (95% CI -0.7 to -12.6)) and week-6 (wrist MD11.8 (95% CI 3.8 to 19.8)). The use of splints was lower in the treatment group odds ratio was 7.2 (95% CI 1.5 to 34.1) and 4.2 (95% CI 1.3 to 14.0) at week-12 and month-6 respectively.Arm-function was not significantly different between the groups MD2.4 (95% CI -5.3 to 10.1) and 2.9 (95% CI -5.8 to 11.6) at week-12 and month-6 respectively. CONCLUSION: BoNTA reduced spasticity and contractures after stroke and effects lasted for approximately 12-weeks. BoNTA reduced the need for concomitant contracture treatment and did not interfere with recovery of arm function. TRIAL REGISTRATION: EudraCT (2010-021257-39) and ClinicalTrials.gov-Identifier: NCT01882556.

Item Type:Article
ISSN:0269-2155
Uncontrolled Keywords:Stroke; arm; botulinum toxin; spasticity; upper limb; Aged; Aged, 80 and over; Botulinum Toxins, Type A; Contracture; Female; Hand Strength; Humans; Male; Middle Aged; Muscle Spasticity; Neuromuscular Agents; Splints; Stroke; Wrist Joint
Group:Faculty of Health & Social Sciences
ID Code:36612
Deposited By: Symplectic RT2
Deposited On:15 Feb 2022 13:19
Last Modified:14 Mar 2022 14:32

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