TY - JOUR
T1 - Outcomes of ambulatory rehabilitation programmes following botulinum toxin for spas ticity in adults with stroke
AU - Demetrios, Marina
AU - Gorelik, Alexandra
AU - Louie, Julie
AU - Brand, Caroline
AU - Baguley, Ian J.
AU - Khan, Fary
PY - 2014/9/1
Y1 - 2014/9/1
N2 - Objective: To examine the benefits of high intensity ambulatory rehabilitation programmes over usual care following botulinum toxin A (BoNT-A) for post-stroke spasticity in Australian adults.Design: Prospective single centre, controlled clinical trial. Participants: Fifty-nine adults, median 61 years old and 2.5 years following stroke.Methods: Participants were dichotomised into high intensity ambulatory rehabilitation programmes (≥ 3 × 1-h weekly sessions for approximately 10 weeks) or usual care programmes (≤ 2 × 1-h weekly sessions) following BoNT-A injections for spasticity. A blinded assessor completed outcomes at 0 (baseline), 6, 12 and 24 weeks. Primary endpoints: proportion of participants achieving ≥ 50% of their goals (using Goal Attainment Scaling: GAS) and GAS T-score change at 12 weeks. Secondary outcomes: Modified Ashworth Scale (MAS), participant satisfaction, activity/participation measures and caregiver burden.Results: Both groups showed significant improvement in goal attainment and participant satisfaction up to 24 weeks, with no overall between-group significant differences. There was, however, a statistical trend (p = 0.052) for participants to achieve more upper limb goals in the high intensity therapy group. GAS and satisfaction benefits persisted beyond the duration of spasticity reduction as measured by MAS.Conclusions: While patient-centred outcomes following BoNT-A injections for post-stroke spasticity were not influenced by intensity of ambulatory rehabilitation programmes, there was a trend for high intensity therapy to be associated with greater upper limb goal attainment. This suggests that the effects of more intensive therapy may be a modifier of the 'black box' of rehabilitation; however, further research is required to evaluate this effect and determine which elements of therapy programmes optimise post-BoNT-A outcomes.
AB - Objective: To examine the benefits of high intensity ambulatory rehabilitation programmes over usual care following botulinum toxin A (BoNT-A) for post-stroke spasticity in Australian adults.Design: Prospective single centre, controlled clinical trial. Participants: Fifty-nine adults, median 61 years old and 2.5 years following stroke.Methods: Participants were dichotomised into high intensity ambulatory rehabilitation programmes (≥ 3 × 1-h weekly sessions for approximately 10 weeks) or usual care programmes (≤ 2 × 1-h weekly sessions) following BoNT-A injections for spasticity. A blinded assessor completed outcomes at 0 (baseline), 6, 12 and 24 weeks. Primary endpoints: proportion of participants achieving ≥ 50% of their goals (using Goal Attainment Scaling: GAS) and GAS T-score change at 12 weeks. Secondary outcomes: Modified Ashworth Scale (MAS), participant satisfaction, activity/participation measures and caregiver burden.Results: Both groups showed significant improvement in goal attainment and participant satisfaction up to 24 weeks, with no overall between-group significant differences. There was, however, a statistical trend (p = 0.052) for participants to achieve more upper limb goals in the high intensity therapy group. GAS and satisfaction benefits persisted beyond the duration of spasticity reduction as measured by MAS.Conclusions: While patient-centred outcomes following BoNT-A injections for post-stroke spasticity were not influenced by intensity of ambulatory rehabilitation programmes, there was a trend for high intensity therapy to be associated with greater upper limb goal attainment. This suggests that the effects of more intensive therapy may be a modifier of the 'black box' of rehabilitation; however, further research is required to evaluate this effect and determine which elements of therapy programmes optimise post-BoNT-A outcomes.
KW - Botulinum toxin
KW - Muscle spasticity
KW - Rehabilitation
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=84921954222&partnerID=8YFLogxK
U2 - 10.2340/16501977-1842
DO - 10.2340/16501977-1842
M3 - Article
C2 - 25073939
AN - SCOPUS:84921954222
VL - 46
SP - 730
EP - 737
JO - Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine
JF - Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine
SN - 1650-1977
IS - 8
ER -