[Abstract] What is the influence of adjunctive therapy on outcome following botulinum neurotoxin (BoNT­A) injection for focal spasticity in adults with neurological conditions?

Abstract:

Neurological disorders are the leading cause of disability worldwide. The upper motor neuron syndrome (UMNS) is a common feature of neurological disorders and describes the changes in motor control that can occur in skeletal muscle after an upper motor neuron lesion. Spasticity is one component of the UMNS that leads to a greater degree of motor impairment compared to those not affected by spasticity. The management of focal spasticity is complex and there are a number of clinical indications for which BoNT-A treatment may be prescribed. Patients may be treated for upper or lower limb spasticity, and may have indications related to active/functional ability (i.e., able to walk) or passive/non-functional (i.e., skin integrity, hygiene or pain) outcomes. Botulinum neurotoxin has been established as effective in reducing spasticity in the upper and lower limbs of adults. However, further research is needed to clearly demonstrate whether the reduction in muscle tone translates into improved function. The international consensus statements for the use of BoNT-A treatment in adults suggest that adjunctive therapies should be continued in conjunction with the BoNT-A injection. Despite this recommendation, the evidence for the independent contribution of adjunctive therapies on patient outcomes has not been determined, and limited evidence exists supporting any specific treatment protocols following BoNT-A injection. The aim of this study was to investigate the influence of commonly prescribed adjunctive therapies on goal attainment following BoNT-A injection for focal spasticity in adults with neurological conditions. A group of 31 adults were provided with a prescribed program from an experienced clinician following their BoNT-A injection designed to maximise their outcome. The rate of adherence to the prescribed program was examined after three months to determine if adherence to therapy improved rehabilitation outcomes in terms of goal attainment as measured by the Goal Attainment Scale. The 31 participants had a total of 76 goals. Active indications for treatment made up the majority of the goals (80.3%). Goals were achieved in 43 out of the 76 cases (56.6%; 95% CI = 42.4-69.8%). Therapy adherence was significantly associated with goal attainment (OR = 1.02, p=0.03, 95% CI=1.00 to 1.04). A higher adherence to therapy increased the odds of goal achievement for active indications (OR = 1.03, 95% CI 1.001-1.05, p = 0.01) but not for passive indications. There was no statistically significant interaction between the location of the injection and adherence to the prescribed therapy program on goal attainment (p = 0.28). Overall, active indications for the BoNT-A injection were most reliant on the prescription of adjunctive therapies following BoNT-A injection.

Source: What is the influence of adjunctive therapy on outcome following botulinum neurotoxin (BoNT­A) injection for focal spasticity in adults with neurological conditions?

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