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

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.

journal_name

Clin Rehabil

journal_title

Clinical rehabilitation

authors

Lindsay C,Ispoglou S,Helliwell B,Hicklin D,Sturman S,Pandyan A

doi

10.1177/0269215520963855

subject

Has Abstract

pub_date

2020-10-11 00:00:00

pages

269215520963855

eissn

0269-2155

issn

1477-0873

pub_type

杂志文章

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