Content » Vol 52, Issue 5

Special report

The role of botulinum toxin in multimodal treatment of spasticity in ambulatory children with spastic cerebral palsy: Extensive evaluation of a cost-effectiveness trial

Johannes B.J Bussmann, Robert F. Pangalila, Henk J. Stam, Fabienne Schasfoort
Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam P.O. BOX 2040, NL-3000 CA Rotterdam, The Netherlands
DOI: 10.2340/16501977-2680

Abstract

A cost-effectiveness trial (the Space Bop study) on the added value of botulinum toxin injections (BoNT-A) in the leg muscles, as part of a multimodal intervention for ambulatory children with spastic cerebral palsy in the context of a single distinct cycle of care was performed recently by our group. For a broad set of effect outcomes, we found that BoNT-A had no added value if children received comprehensive rehabilitationHowever, this counterintuitive finding was met with scepticism.
Since several noteworthy facts and experiences were recorded during the course of the trial and the dissemination phase, the aim of this paper was to describe and discuss some crucial aspects of, and barriers to, the Space Bop study, related to context and perspective, design and results, as well as publication and implementation.
This paper discusses 5 issues: () the design, interpretation and presentation of previous research; () the role of one’s own clinical experience and interpretation; () the aims of (BoNT-A) treatment; () conflict of interest, role of industry, and the role of history; () optimal treatment modalities and dose–response relationships.
Despite the unambiguous findings from the Space Bop study, several factors hindered acceptance of the results. Awareness of these factors is important when performing rehabilitation research and disseminating and implementing research findings.

Lay Abstract

Recently, we performed a study on the added value of botulinum toxin injections (BoNT-A) for ambulatory children with spastic cerebral palsy (the Space Bop study). The results showed that BoNT-A did not add any value in this context, but this counterintuitive finding was met with scepticism. The aim of this paper is to describe and discuss some crucial aspects of, and barriers to, the Space Bop study. The paper also discusses the design, interpretation and presentation of previous research; the role of clinician’s own experience and interpretation; the aims of (BoNT-A) treatment; conflict of interest, role of industry, and the role of history; and optimal treatment modalities and dose–response relationships. We conclude that several factors hindered acceptance of the Space Bop results. Awareness of these factors is important when performing rehabilitation research and disseminating and implementing research findings.

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