Article

OBJECTIVE: To determine the quality of evidence from randomized controlled trials
on the efficacy of adjunct therapies following botulinum toxin injections for
limb spasticity. DATA SOURCES: MEDLINE, EMBASE, CINAHL,
and Cochrane Central
Register of Controlled Trials electronic databases were searched for English
language human studies from 1980 to 21 May 2015. STUDY SELECTION: Randomized
controlled trials assessing adjunct therapies postbotulinum toxin injection for
treatment of spasticity were included. Of the 268 studies screened, 17 met
selection criteria. DATA EXTRACTION: Two reviewers independently assessed risk of
bias using the Physiotherapy Evidence Database (PEDro) scale and graded according
to Sackett's levels of evidence. DATA SYNTHESIS:
Ten adjunct therapies were
identified. Evidence suggests that adjunct use of electrical stimulation,
modified constraint-induced movement therapy, physiotherapy (all Level 1),
casting and dynamic splinting (both Level 2) result in improved Modified Ashworth
Scale scores by at least 1 grade. There is Level 1 and 2 evidence that adjunct
taping, segmental muscle vibration, cyclic functional electrical stimulation, and
motorized arm ergometer may not improve outcomes compared with botulinum toxin
injections alone. There is Level 1 evidence that casting is better than taping,
taping is better than electrical stimulation and stretching, and extracorporeal
shock wave therapy is better than electrical stimulation for outcomes including
the Modified Ashworth Scale, range of motion and gait. All results are based on
single studies. CONCLUSION: There is high level evidence to suggest that adjunct
therapies may improve outcomes following botulinum toxin injection. No results
have been confirmed by independent replication. All interventions would benefit
from further study.
CI - (c) The Author(s) 2015.

Langue : ANGLAIS