title: Outcomes of ambulatory rehabilitation programmes following botulinum toxin for spasticity in adults with stroke.
abstract: OBJECTIVE
  To examine the benefits of high intensity ambulatory rehabilitation programmes over usual care following botulinum toxin A (BoNT-A) for post-stroke spasticity in Australian adults.
  
  
  METHODS
  Prospective single centre, controlled clinical trial.
  
  
  METHODS
  Fifty-nine adults, median 61 years old and 2.5 years following stroke.
  
  
  METHODS
  PARTICIPANTS were dichotomised into high intensity ambulatory rehabilitation programmes (≥ 3 × 1-h weekly sessions for approximately 10 weeks) or usual care programmes (≤ 2 × 1-h weekly sessions) following BoNT-A injections for spasticity. A blinded assessor completed outcomes at 0 (baseline), 6, 12 and 24 weeks. Primary endpoints: proportion of participants achieving ≥ 50% of their goals (using Goal Attainment Scaling: GAS) and GAS T-score change at 12 weeks.
  
  
  RESULTS
  Modified Ashworth Scale (MAS), participant satisfaction, activity/participation measures and caregiver burden.
  
  
  RESULTS
  Both groups showed significant improvement in goal attainment and participant satisfaction up to 24 weeks, with no overall between-group significant differences. There was, however, a statistical trend (p = 0.052) for participants to achieve more upper limb goals in the high intensity therapy group. GAS and satisfaction benefits persisted beyond the duration of spasticity reduction as measured by MAS.
  
  
  CONCLUSIONS
  While patient-centred outcomes following BoNT-A injections for post-stroke spasticity were not influenced by intensity of ambulatory rehabilitation programmes, there was a trend for high intensity therapy to be associated with greater upper limb goal attainment. This suggests that the effects of more intensive therapy may be a modifier of the 'black box' of rehabilitation; however, further research is required to evaluate this effect and determine which elements of therapy programmes optimise post-BoNT-A outcomes.
authors: Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne Health, 3052 Parkville, Australia. mdemetrios@hotmail.com, Marina.Demetrios@mh.org.au.
authors: Marina
authors: M
authors: Demetrios
authors: Alexandra
authors: A
authors: Gorelik
authors: Julie
authors: J
authors: Louie
authors: Caroline
authors: C
authors: Brand
authors: Ian J
authors: IJ
authors: Baguley
authors: Fary
authors: F
authors: Khan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods; D001315:Australia; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D017028:Caregivers; D005121:Extremities / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy / Q000209:etiology / Q000534:rehabilitation*; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000188:drug therapy; D000071939:Stroke Rehabilitation; D013997:Time Factors; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A