Outcomes of ambulatory rehabilitation programmes following botulinum toxin for spasticity in adults with stroke
Marina Demetrios, Alexandra Gorelik , Julie Louie , Caroline Brand, Ian J. Baguley, Fary Khan
Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne Health, 3052 Parkville, Australia. E-mail: Marina.Demetrios@mh.org.au
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.
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