A systematic review: efficacy of botulinum toxin in walking and quality of life in post-stroke lower limb spasticity

Abstract

BackgroundImproved walking is one of the highest priorities in people living with stroke. Post-stroke lower limb spasticity (PSLLS) impedes walking and quality of life (QOL). The understanding of the evidence of improved walking and QOL following botulinum toxin (BoNTA) injection is not clear. We performed a systematic review of the randomized control trials (RCT) to evaluate the effectiveness of BoNTA injection on walking and QOL in PSLLS.MethodsWe searched PubMed, Web of Science, Embase, CINAHL, ProQuest Thesis and Dissertation checks, Google Scholar, WHO International Clinical Trial Registry Platform, ClinicalTrials.gov, Cochrane, and ANZ and EU Clinical Trials Register for RCTs looking at improvement in walking and QOL following injection of BoNTA in PSLLS. The original search was carried out prior to 16 September 2015. We conducted an additional verifying search on CINHAL, EMBASE, and MEDLINE (via PubMed) from 16 September 2015 to 6 June 2017 using the same clauses as the previous search. Methodological quality of the individual studies was critically appraised using Joanna Briggs Institute’s instrument. Only placebo-controlled RCTs looking at improvement in walking and QOL were included in the review.ResultsOf 2026 records, we found 107 full-text records. Amongst them, we found five RCTs qualifying our criteria. No new trials were found from the verifying search. Two independent reviewers assessed methodological validity prior to inclusion in the review using Joanna Briggs Institute’s appraisal instrument. Two studies reported significant improvement in gait velocity (p = 0.020) and < 0.05, respectively. One study showed significant improvement in 2-min-walking distance (p < 0.05). QOL was recorded in one study without any significant improvement. Meta-analysis of reviewed studies could not be performed because of different methods of assessing walking ability, small sample size with large confidence interval and issues such as lack of power calculations in some studies. Findings from our systematic and detailed study identify the need for a well-designed RCT to adequately investigate the issues highlighted.ConclusionsThis review could not conclude there was sufficient evidence to support or refute improvement on walking or QOL following BoNTA injection. Reasons for this are discussed, and methods for future RCTs are developed.

Pharmacists’ Preparedness to Patients Education at the Time of Pandemic—A Cross-Sectional Study with an Example of SARS-CoV-2 Outbreak in Poland

“…The availability and frequency with which patients visit community pharmacies in comparison with other healthcare facilities places their employees among the first healthcare professionals contacted by patients with inquiries on health-related issues [ 1 , 2 , 3 ]. This process is additionally reinforced by the limited access to medical services, which prompts patients to search for other sources of information or medical assistance.…”

Studies on Spasticity from an Interventional Perspective

“…The effect on reduction of muscle tone is conclusive. Evidence for improvements in activity, participation and HRQoL is emerging, though still not conclusive [133,135]. It seems that a gain in activity and participation is an adaptive process, needing repeated treatments in conjunction with training [136].…”

Retraining Reflexes: Clinical Translation of Spinal Reflex Operant Conditioning

“…Currently, the treatment of motor impairments, such as spasticity, includes rehabilitation (physical and occupational therapy [14]) and pharmacological interventions [15][16][17][18][19][20]. Examples of treatments based on rehabilitation are therapeutic exercise [21], stretching [21,22], and mobility and gait training [22,23].…”

“…These functional training regimes may include devising new strategies to accommodate motor impairments; and assistive devices may be prescribed to support achievement of patients' functional goals. Pharmacological solutions, such as antispasmodics (e.g., baclofen) and neurotoxins (e.g., botulinum toxin) aim to relieve the symptoms of spasticity by reducing muscle activity [15][16][17][18][19][20].…”