title: The early use of botulinum toxin in post-stroke spasticity: study protocol for a randomised controlled trial.
abstract: BACKGROUND
  Patients surviving stroke but who have significant impairment of function in the affected arm are at more risk of developing pain, stiffness and contractures. The abnormal muscle activity, associated with post-stroke spasticity, is thought to be causally associated with the development of these complications. Treatment of spasticity is currently delayed until a patient develops signs of these complications.
  
  
  METHODS
  This protocol is for a phase II study that aims to identify whether using OnabotulinumtoxinA (BoNT-A) in combination with physiotherapy early post stroke when initial abnormal muscle activity is neurophysiologically identified can prevent loss of range at joints and improve functional outcomes.The trial uses a screening phase to identify which people are appropriate to be included in a double blind randomised placebo-controlled trial. All patients admitted to Sandwell and West Birmingham NHS Trust Hospitals with a diagnosis of stroke will be screened to identify functional activity in the arm. Those who have no function will be appropriate for further screening. Patients who are screened and have abnormal muscle activity identified on EMG will be given electrical stimulation to forearm extensors for 3 months and randomised to have either injections of BoNT-A or normal saline. The primary outcome measure is the action research arm test - a measure of arm function. Further measures include spasticity, stiffness, muscle strength and fatigue as well as measures of quality of life, participation and caregiver strain.
  
  
  BACKGROUND
  ISRCTN57435427, EudraCT2010-021257-39, NCT01882556.
authors.affiliation: Physiotherapy Department, Sandwell and West Birmingham NHS Trust and School of Health and Rehabilitation, Keele University, Mackay Building, Keele, Staffordshire ST5 5BG, UK. Camlin3@hotmail.com.
authors.forename: Cameron
authors.initials: C
authors.lastname: Lindsay
authors.forename: Julie
authors.initials: J
authors.lastname: Simpson
authors.forename: Sissi
authors.initials: S
authors.lastname: Ispoglou
authors.forename: Steve G
authors.initials: SG
authors.lastname: Sturman
authors.forename: Anand D
authors.initials: AD
authors.lastname: Pandyan
mesh_terms: D001696:Biomechanical Phenomena; D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use*; D002985:Clinical Protocols; D004311:Double-Blind Method; D004739:England; D006801:Humans; D009128:Muscle Spasticity / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000187:drug effects* / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D012107:Research Design; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A