Article

Botulinum toxin A (BoNT-A) injections are increasingly used to treat
muscle spasticity and are often complemented by adjunctive rehabilitation
therapies; however, little is known about the effect of therapy after injection.
The aim of this study was to identify and summarize evidence on
rehabilitation therapies used after BoNT-A injections to improve motor function
in adults with neurological impairments. DATA SOURCES: Searches were conducted in
PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL,
National Research Register, metaRegistry of Controlled Trials, PEDro, and
OTseeker. STUDY SELECTION: Randomized and quasi-randomized controlled trials were
considered for inclusion. Participants with neurological impairments received
BoNT-A to treat focal spasticity in limbs, with rehabilitation interventions
provided to experimental groups only. Primary outcome measures were joint
mobility, function of the affected limb, and spasticity. Eleven studies with 234
participants, most of whom had stroke, were included in the review. DATA
EXTRACTION: Two reviewers extracted study details and data. DATA SYNTHESIS:
Methodological quality was rated using the PEDro scale. Both fixed-effects and
random-effects models were used to calculate effect size. RESULTS: Studies were
of variable quality: 3 were poor (PEDro score 1 to 4), and 8 were moderate (PEDro
score 6 to 7). No study investigated effects for longer than 24 weeks (6 months).
Included trials presented 9 therapy types, including ergometer cycling,
electrical stimulation, stretch (casting, splinting, taping, or manual or
exercise-induced stretch), constraint-induced movement therapy, task-specific
motor training, and exercise programs. Statistical findings suggest that combined
therapy and BoNT-A is slightly more effective than BoNT-A alone. CONCLUSION:
Evidence relating to impact of adjunct therapy is available, but the
heterogeneity of studies limits the opportunity to demonstrate overall impact.
Researchers need to consider the benefits of greater consistency in study
approaches and measures so that meaningful evaluations of overall adjunct therapy
effects can be made.
CI - (c) 2014 American Physical Therapy Association.

Langue : ANGLAIS