Article

Limited empirical information exists regarding botulinum toxin-A
injector decision-making practices for adult upper limb post-stroke spasticity.
The design of most studies prevents such an assessment,
as injection sites and
dosage are mandated by researcher protocols. This contrasts to usual injector
practices, where individualized decision-making is the standard of care. DESIGN:
Secondary data analysis from an Australian randomized controlled trial of 90
adults with upper limb post-stroke spasticity where experienced clinicians
followed their standard clinical injecting practice rather than a mandated
injection regimen. METHODS: Clinicians were hypothesized to tailor their
injection practices according to the subject's degree of spasticity and/or the
type of functional gain desired. Hypothesis testing was conducted using
non-parametric analysis. RESULTS: Muscle selection and botulinum toxin-A dosage
were not significantly associated with spasticity severity or with
patient-identified goals. Between-site differences in injection practices
suggested that injector beliefs, rather than patient characteristics, were the
dominant feature driving botulinum toxin-A injection strategy for post-stroke
upper limb spasticity. CONCLUSION: This result looks into the "black box" of
rehabilitation, revealing significant variation in injector beliefs. Findings
suggest that further scientific work is required to maximize the efficacy of botulinum toxin-A injections in post-stroke upper limb spasticity management.

Langue : ANGLAIS