VALUE OF BOTULINUM TOXIN INJECTIONS PRECEDING A COMPREHENSIVE REHABILITATION PERIOD FOR CHILDREN WITH SPASTIC CEREBRAL PALSY: A COST-EFFECTIVENESS STUDY
| Autor: | Suzanne Polinder, Annet J. Dallmeijer, Fabiënne C Schasfoort, Ewout W. Steyerberg, Johannes B. J. Bussmann, Coriene Catsman, Robert F. Pangalila, Henk J. Stam, Jules G. Becher |
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| Přispěvatelé: | Rehabilitation Medicine, Neurology, Public Health, Rehabilitation medicine, Amsterdam Movement Sciences - Restoration and Development, APH - Health Behaviors & Chronic Diseases, APH - Societal Participation & Health |
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Cost effectiveness medicine.medical_treatment Cost-Benefit Analysis Gross motor skill Physical Therapy Sports Therapy and Rehabilitation RM1-950 spasticcerebralpalsy Cerebral palsy 03 medical and health sciences 0302 clinical medicine Spastic cerebral palsy medicine Humans 030212 general & internal medicine Botulinum Toxins Type A Child 030222 orthopedics Rehabilitation business.industry physio-therapy Cerebral Palsy Gross Motor Function Classification System General Medicine medicine.disease Botulinum toxin Treatment Outcome Neuromuscular Agents Child Preschool Ambulatory Physical therapy cost-effectiveness Female Therapeutics. Pharmacology business botulinumtoxin medicine.drug |
| Zdroj: | Schasfoort, F, Dallmeijer, A, Pangalila, R, Catsman, C, Stam, H, Becher, J, Steyerberg, E, Polinder, S & Bussmann, J 2018, ' VALUE OF BOTULINUM TOXIN INJECTIONS PRECEDING A COMPREHENSIVE REHABILITATION PERIOD FOR CHILDREN WITH SPASTIC CEREBRAL PALSY: A COST-EFFECTIVENESS STUDY ', Journal of Rehabilitation Medicine, vol. 50, no. 1, pp. 22-29 . https://doi.org/10.2340/16501977-2267 Journal of Rehabilitation Medicine, 50(1), 22-29. Foundation for Rehabilitation Information Journal of Rehabilitation Medicine, Vol 50, Iss 1, Pp 22-29 (2017) |
| ISSN: | 1651-2081 1650-1977 |
| DOI: | 10.2340/16501977-2267 |
| Popis: | Objective: Despite the widespread use of botulinum toxin in ambulatory children with spastic cerebral palsy, its value prior to intensive physiotherapy with adjunctive casting/orthoses remains unclear. Design: A pragmatically designed, multi-centre trial, comparing the effectiveness of botulinum toxin + intensive physiotherapy with intensive physiotherapy alone, including economic evaluation. Subjects/patients: Children with spastic cerebral palsy, age range 4–12 years, cerebral palsy-severity Gross Motor Function Classification System levels I–III, received either botulinum toxin type A + intensive physiotherapy or intensive physiotherapy alone and, if necessary, ankle-foot orthoses and/or casting. Methods: Primary outcomes were gross motor func-tion, physical activity levels, and health-related quality-of-life, assessed at baseline, 12 (primary end-point) and 24 weeks (follow-up). Economic outcomes included healthcare and patient costs. Intention-to-treat analyses were performed with linear mixed models. Results: There were 65 participants (37 males), with a mean age of 7.3 years (standard deviation 2.3 years), equally distributed across Gross Motor Function Classification System levels. Forty-one children received botulinum toxin type A plus intensive physio-therapy and 24 received intensive physiotherapy treatment only. At primary end-point, one statistically significant difference was found in favour of intensive physiotherapy alone: objectively measured percentage of sedentary behaviour (–3.42, 95% confidence interval 0.20–6.64, p=0.038). Treatment costs were significantly higher for botulinum toxin type A plus intensive physiotherapy (8,963 vs 6,182 euro, p=0.001). No statistically significant differences were found between groups at follow-up. Conclusion: The addition of botulinum toxin type A to intensive physiotherapy did not improve the effectiveness of rehabilitation for ambulatory children with spastic cerebral palsy and was also not cost-effective. Thus botulinum toxin is not recommended for use in improving gross motor function, activity levels or health-related quality-of-life in this cerebral palsy age- and severity-subgroup. |
| Databáze: | OpenAIRE |
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