Article

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 x 1-h weekly sessions for
approximately 10 weeks) or usual care programmes
(</= 2 x 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.

Langue : ANGLAIS