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Auteur Aukje Andringa
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Effectiveness of Botulinum Toxin Treatment for Upper Limb Spasticity Poststroke Over Different ICF Domains: A Systematic Review and Meta-Analysis / Aukje Andringa in Archives of Physical Medicine and Rehabilitation, Vol. 100, n° 9 (2019)
Titre : Effectiveness of Botulinum Toxin Treatment for Upper Limb Spasticity Poststroke Over Different ICF Domains: A Systematic Review and Meta-Analysis Type de document : Article Auteurs : Aukje Andringa ; Ingrid van de Port ; Erwin van Wegen Année de publication : 2019 Article en page(s) : p. 1703-1725 Langues : Anglais (eng) Descripteurs : HE Vinci
Accident vasculaire cérébral (AVC) ; Méta-analyse ; Rééducation et réadaptation ; Spasticité musculaire ; Toxines botuliniques ou botuliques
Résumé : Objective
To provide a comprehensive overview of reported effects and scientific robustness of botulinum toxin (BoNT) treatment regarding the main clinical goals related to poststroke upper limb spasticity, using the International Classification of Functioning, Disability and Health.
Embase, PubMed, Wiley/Cochrane Library, and Ebsco/CINAHL were searched from inception up to May 16, 2018.
We included randomized controlled trials comparing upper limb BoNT injections with a control intervention in patients with a history of stroke. A total of 1212 unique records were screened by 2 independent reviewers. Forty trials were identified, including 2718 patients with history of stroke.
Outcome data were pooled according to assessment timing (ie, 4-8wk and 12wk after injection), and categorized into 6 main clinical goals (ie, spasticity-related pain, involuntary movements, passive joint motion, care ability, arm and hand use, and standing and walking performance). Sensitivity analyses were performed for the influence of study and intervention characteristics, involvement of pharmaceutical industry, and publication bias.
Robust evidence is shown for the effectiveness of BoNT in reducing resistance to passive movement, as measured with the (Modified) Ashworth Score, and improving self-care ability for the affected hand and arm after intervention (P<.005 and at follow-up in addition robust evidence is shown for the absence of effect on arm-hand capacity follow-up. bont was found to significantly reduce involuntary movements spasticity-related pain caregiver burden improve passive range motion while no arm hand use after intervention.> Conclusions
In view of the robustness of current evidence, no further trials are needed to investigate BoNT for its favorable effects on resistance to passive movement of the spastic wrist and fingers, and on self-care. No trials are needed to further confirm the lack of effects of BoNT on arm-hand capacity, whereas additional trials are needed to establish the suggested favorable effects of BoNT on other body functions, which may result in clinically meaningful outcomes at activity and participation levels.
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in Archives of Physical Medicine and Rehabilitation > Vol. 100, n° 9 (2019) . - p. 1703-1725[article]