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Title: Long-term effect of additional rehabilitation following botulinum toxin-A on upper limb activity in chronic stroke: the InTENSE randomised trial.
Austin Authors: Lannin, Natasha A;Ada, Louise;English, Coralie;Ratcliffe, Julie;Faux, Steven;Palit, Mithu;Gonzalez, Senen ;Olver, John;Schneider, Emma;Crotty, Maria;Cameron, Ian D
Affiliation: Austin Health
School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
Sacred Heart Rehabilitation Unit, St Vincent's Hospital, Sydney, Australia
Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
Alfred Health, Melbourne, Australia
School of Allied Health (Occupational Therapy), La Trobe University, Melbourne, Australia
School of Medicine, University of New South Wales, Sydney, Australia
Epworth Monash Rehabilitation Medicine Research Unit, Monash University, Melbourne, Australia
Alfred Health, Melbourne, Australia
College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
Rehabilitation and Aged Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia
John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, Australia
The University of Sydney, Sydney, Australia
Issue Date: 25-Apr-2022
Date: 2022
Publication information: BMC Neurology 2022; 22(1): 154
Abstract: It is common for people with persistent spasticity due to a stroke to receive an injection of botulinum toxin-A in the upper limb, however post-injection intervention varies. To determine the long-term effect of additional upper limb rehabilitation following botulinum toxin-A in chronic stroke. An analysis of long-term outcomes from national, multicenter, Phase III randomised trial with concealed allocation, blinded measurement and intention-to-treat analysis was carried out. Participants were 140 stroke survivors who were scheduled to receive botulinum toxin-A in any muscle(s) that cross the wrist because of moderate to severe spasticity after a stroke greater than 3 months ago, who had completed formal rehabilitation and had no significant cognitive impairment. Experimental group received botulinum toxin-A plus 3 months of evidence-based movement training while the control group received botulinum toxin-A plus a handout of exercises. Primary outcomes were goal attainment (Goal Attainment Scale) and upper limb activity (Box and Block Test) at 12 months (ie, 9 months beyond the intervention). Secondary outcomes were spasticity, range of motion, strength, pain, burden of care, and health-related quality of life. By 12 months, the experimental group scored the same as the control group on the Goal Attainment Scale (MD 0 T-score, 95% CI -5 to 5) and on the Box and Block Test (MD 0.01 blocks/s, 95% CI -0.01 to 0.03). There were no differences between groups on any secondary outcome. Additional intensive upper limb rehabilitation following botulinum toxin-A in chronic stroke survivors with a disabled upper limb is not more effective in the long-term. ACTRN12615000616572 (12/06/2015).
DOI: 10.1186/s12883-022-02672-8
Journal: BMC Neurology
PubMed URL: 35468766
PubMed URL:
Type: Journal Article
Subjects: Botulinum toxin type A
Appears in Collections:Journal articles

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