Rehabilitation therapies after botulinum toxin-a injection to manage limb spasticity

Botulinum toxin A (BoNT-A) injections being used to treat muscle spasticity more frequently and are often complemented by adjunctive rehabilitation therapies; however, not much is known about the effect of therapy after injection. The objective 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. 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. 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 indicate that combined therapy and BoNT-A is slightly more effective than BoNT-A alone.

Evidence relating to effect of adjunct therapy is available, but the heterogeneity of studies limits the opportunity to demonstrate overall impact. Researchers need to consider the benefits of increased consistency in study approaches and measures so that meaningful evaluations of overall adjunct therapy effects can be made.

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