Outcomes of ambulatory rehabilitation programmes following botulinum toxin for spasticity in
adults with stroke
Sammanfattning
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.