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Treatment with botulinum toxin improves upper-extremity function post stroke: a systematic review and meta-analysis
Norine Foley1, Shelialah Pereira, Katherine Salter
1Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, Parkwood Hospital Site, London, Ontario, Canada. norine.foley@sjhc.london.on.ca
Archives of Physical Medicine and Rehabilitation
|December 25, 2012
Summary
Botulinum toxin type A (BTX-A) injections moderately improved upper-extremity function in stroke survivors. This treatment offers a viable option for enhancing activity capacity and performance post-stroke.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Pharmacology
Background:
- Post-stroke spasticity in the upper extremity significantly impacts patient function.
- Limited evidence exists on the efficacy of specific treatments for improving activity capacity in this population.
Purpose of the Study:
- To evaluate the effectiveness of botulinum toxin type A (BTX-A) in improving upper-extremity activity capacity and performance in stroke survivors.
- To synthesize findings from randomized controlled trials (RCTs) on BTX-A for post-stroke spasticity.
Main Methods:
- A systematic literature search was conducted across major databases (MEDLINE, EMBASE, Scopus, ISI Web of Science) from 1985 to November 2011.
- Included RCTs compared BTX-A with placebo or non-pharmacologic treatments in adult stroke survivors with moderate to severe upper-extremity spasticity.
- Data on activity limitations were extracted and analyzed using the International Classification of Functioning, Disability and Health framework.
Main Results:
- Sixteen RCTs were identified, with 10 (n=1000) included in the pooled analysis.
- Six distinct outcome measures assessed activity limitations, including the Disability Assessment Scale, Action Research Arm Test, and Barthel Index.
- BTX-A demonstrated a moderate, statistically significant treatment effect (SMD=.536, 95% CI=.352-.721, P<.0001).
Conclusions:
- Botulinum toxin type A (BTX-A) treatment is associated with moderate improvements in upper-extremity activity capacity and performance following a stroke.
- BTX-A represents a beneficial therapeutic option for managing post-stroke upper-limb spasticity and functional deficits.
