Investigating muscle selection for botulinum toxin-A injections in adults with post-stroke upper limb spasticity

Ian J. Baguley, Melissa Nott, Lynne Turner-Stokes, Stephen De Graff, Pesi Katrak, Paul McCrory, Monica De Abadal, Andrew Hughes

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Abstract

Background: Limited empirical information exists regardingbotulinum toxin-A injector decision-making practices foradult upper limb post-stroke spasticity. The design of moststudies prevents such an assessment, as injection sites anddosage are mandated by researcher protocols. This contraststo usual injector practices, where individualized decisionmakingis the standard of care.Design: Secondary data analysis from an Australian randomizedcontrolled trial of 90 adults with upper limb poststrokespasticity where experienced clinicians followed theirstandard clinical injecting practice rather than a mandatedinjection regimen.Methods: Clinicians were hypothesized to tailor their injectionpractices according to the subject's degree of spasticityand/or the type of functional gain desired. Hypothesis testingwas conducted using non-parametric analysis.Results: Muscle selection and botulinum toxin-A dosagewere not significantly associated with spasticity severity orwith patient-identified goals. Between-site differences in injectionpractices suggested that injector beliefs, rather thanpatient characteristics, were the dominant feature drivingbotulinum toxin-A injection strategy for post-stroke upperlimb 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 tomaximize the efficacy of botulinum toxin-A injections inpost-stroke upper limb spasticity management.Key words: Muscle spasticity; botulinum toxin A; stroke; upperlimb; rehabilitation; clinical reasoning.
Original languageEnglish
Pages (from-to)1032-1037
Number of pages6
JournalJournal of Rehabilitation Medicine
Volume43
Issue number11
DOIs
Publication statusPublished - Nov 2011

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    Baguley, I. J., Nott, M., Turner-Stokes, L., De Graff, S., Katrak, P., McCrory, P., De Abadal, M., & Hughes, A. (2011). Investigating muscle selection for botulinum toxin-A injections in adults with post-stroke upper limb spasticity. Journal of Rehabilitation Medicine, 43(11), 1032-1037. https://doi.org/10.2340/16501977-0885