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.
journal_name
J Rehabil Medjournal_title
Journal of rehabilitation medicineauthors
Baguley IJ,Nott MT,Turner-Stokes L,De Graaff S,Katrak P,McCrory P,de Abadal M,Hughes Adoi
10.2340/16501977-0885subject
Has Abstractpub_date
2011-11-01 00:00:00pages
1032-7issue
11eissn
1650-1977issn
1651-2081journal_volume
43pub_type
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