title: The efficacy of Botulinum Toxin A on improving ease of care in the upper and lower limbs: a systematic review and meta-analysis using the Grades of Recommendation, Assessment, Development and Evaluation approach.
abstract: OBJECTIVE
  A systematic review and meta-analysis using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach; evaluating Botulinum Toxin type A efficacy on improving ease of care in the upper/lower limb.
  
  
  METHODS
  Pubmed, Cinahl, Amed, Embase and Cochrane databases. English Language. Search to July 2014.
  
  
  METHODS
  All randomized, placebo controlled trials on adults with difficulty in caring for the upper/lower limb resulting from spasticity of any origin and treated with a single dose of Botulinum Toxin A. Evidence quality was assessed by GRADE.
  
  
  RESULTS
  A total of 32 studies were reviewed. Meta-analysis was carried out on 11 upper limb and three lower limb studies. Evidence quality for the upper limb was moderate. A significant result for Botulinum Toxin A was found at four to 12 weeks for the upper limb (SMD 0.80, CI 0.55, 1.06, p < 0.0001). The effects were maintained for up to six months (SMD 0.48, CI 0.34, 0.62, p < 0.0001). Evidence quality was very low for the lower limb. Meta-analysis was only possible for global assessment of benefit. No significant effect was found. (
  
  
  METHODS
  RR 1.37 CI (0.94, 2.00) p = 0.11; clinician: RR 1.06 (0.84, 1.34) p = 0.60.)
  
  
  CONCLUSIONS
  Botulinum Toxin A improves ease of care in the upper limb for up to six months. No conclusion can be drawn for the lower limb.
authors.affiliation: South Hams Physiotherapy Ltd, Ivybridge, UK jennyjas1@yahoo.co.uk.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Baker
authors.affiliation: Telethon Institute for Child Health Research, The University of Western Australia, Perth, Australia.
authors.forename: Gavin
authors.initials: G
authors.lastname: Pereira
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D006801:Humans; D035002:Lower Extremity; D009128:Muscle Spasticity / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D034941:Upper Extremity
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin; meta-analysis; systematic review