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Investigating muscle selection for botulinum toxin-A injections in adults with post-stroke upper limb spasticity.
MedLine Citation:
PMID:  22031350     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: 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.
Authors:
Ian J Baguley; Melissa T Nott; Lynne Turner-Stokes; Stephen De Graaff; Pesi Katrak; Paul McCrory; Monica de Abadal; Andrew Hughes
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine     Volume:  43     ISSN:  1651-2081     ISO Abbreviation:  J Rehabil Med     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-10-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101088169     Medline TA:  J Rehabil Med     Country:  Sweden    
Other Details:
Languages:  eng     Pagination:  1032-7     Citation Subset:  IM    
Affiliation:
Westmead Hospital and The University of Sydney. E-mail: ian.baguley@swahs.health.nsw.gov.au.
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