The Lack of Effect of Botulinum Toxin-A on Upper Limb Activity in Chronic Stroke: A Short Report from the InTENSE Trial.

Autor: Cameron ID; John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia.; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia., Ada L; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia., Crotty M; College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia.; Flinders Medical Centre, Bedford Park, SA 5042, Australia., Palit M; Alfred Health, Melbourne, VIC 3004, Australia., Huang L; Flinders Medical Centre, Bedford Park, SA 5042, Australia., Olver J; Epworth Monash, Rehabilitation Research Unit, Richmond, VIC 3121, Australia., Faux SG; Sacred Heart Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, NSW 2010, Australia.; St Vincent's Clinical School, University of New South Wales, Sydney, NSW 2033, Australia., Gonzales S; Austin Hospital, Heidelberg, VIC 3084, Australia., Anthonisz B; Alfred Health, Melbourne, VIC 3004, Australia., Bowman M; St Joseph's Hospital, St Vincent's HealthCare, East Sydney, NSW 2010, Australia., Watanabe Y; Sacred Heart Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, NSW 2010, Australia., Chow Y; Austin Hospital, Heidelberg, VIC 3084, Australia., Milte R; Caring Futures Institute, Flinders University, Bedford Park, SA 5042, Australia., Ratcliffe J; Caring Futures Institute, Flinders University, Bedford Park, SA 5042, Australia., English CK; Heart and Stroke Program, School of Health Sciences, University of Newcastle, Callaghan, NSW 2308, Australia.; Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia., Lannin NA; Alfred Health, Melbourne, VIC 3004, Australia.; Department of Neurosciences, Central Clinical School, Monash University, Clayton, VIC 3800, Australia.
Jazyk: angličtina
Zdroj: Toxins [Toxins (Basel)] 2024 Nov 26; Vol. 16 (12). Date of Electronic Publication: 2024 Nov 26.
DOI: 10.3390/toxins16120510
Abstrakt: We examined the effect of botulinum toxin-A on upper limb impairments and activity limitations in chronic stroke. This study is a secondary analysis of control group data from a national, multicenter, Phase III randomized trial with a masked outcome assessment. We studied 71 stroke survivors who received a botulinum toxin-A injection in any muscle(s) that crosses the wrist due to significant spasticity after a stroke greater than 3 months previously. We measured upper limb activity, spasticity, range of motion, grip strength, pain and other outcomes at injection and three months later. The median difference between injection and 3 months later was 0.0 blocks/s (interquartile range (IQR) 0.0) on the Box and Block Test, 0/4 (IQR 1) on the Tardieu Scale, 4 degrees (IQR 26) of wrist extension, 0.0 kg (IQR 2) of grip strength, 0.0 (IQR 1.5) on the 10 cm visual analogue scale for pain, 0/100 (IQR 21) on the 10 cm visual analogue scale for overall health, 0/3 (IQR 0) for self-care and -2 (IQR 8) for burden of care. In chronic stroke survivors who have little activity in their upper limb, botulinum toxin-A is not effective in improving any measured outcomes and does not appear to be clinically justified in this population with severe activity limitations.
Databáze: MEDLINE