title: Systematic review of upper-limb function measurement methods in botulinum toxin intervention for focal spasticity.
abstract: OBJECTIVE
  This paper aimed to select studies evaluating botulinum toxin (BoNT) intervention applied for upper-limb spasticity and from these identify outcome measures that are a) applicable in the hemiparetic upper limb and b) include evaluation of functional outcome in the context of everyday real-life activities.
  
  
  METHODS
  A systematic search was used to identify peer-reviewed papers evaluating BoNT intervention for focal spasticity management in the upper limb. From these papers, outcome evaluation methods were identified, which attempted to capture 'active function' improvement (functional use of the hand and/or arm) or passive function improvement (care for the affected limb, for example to maintain hygiene and dress or support the arm).
  
  
  RESULTS
  The search yielded 411 studies. Seventy papers were identified following a final review of the abstracts as potentially including evaluation of functional outcome (active and/or passive function). Following the review of the papers, a total of 22 studies contained specific methods for evaluating functional outcome in the upper limb.
  
  
  CONCLUSIONS
  Three different patient-focused methods to evaluate functional outcome following focal spasticity intervention using BoNT have been identified: 1) use of patient report of upper-limb items (including the Leeds Adult Spasticity Impact Scale and the Disability Assessment Scale), 2) use of a composite measure of function incorporating functional items and 3) Goal Attainment Scaling. None of these methods fully address evaluation of functional outcome in this context but may go some way to recording these improvements. An alternative or complementary measure, recently published, is the Arm Activity Measure for evaluation of active and passive function in this context. The Arm Activity Measure addresses active and passive function changes from the perspective of patients and carers and has been developed for application in this context.
authors: Regional Rehabilitation Unit, Northwick Park Hospital, London, UK. Stephen.Ashford@nhs.net
authors: Stephen
authors: S
authors: Ashford
authors: Lynne
authors: L
authors: Turner-Stokes
mesh_terms: D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use*; D001132:Arm / Q000503:physiopathology; D001905:Botulinum Toxins / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation; D017028:Caregivers; D004185:Disability Evaluation; D006305:Health Status Indicators; D006801:Humans; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D017063:Outcome Assessment, Health Care; D020127:Recovery of Function; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D034941:Upper Extremity / Q000503:physiopathology*
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins
keywords: brain injury; spasticity; upper-limb function