title: The effectiveness of therapy on outcome following (BoNT-A) injection for focal spasticity in adults with neurological conditions: A systematic review.
abstract: OBJECTIVE
  To determine the independent effectiveness of adjunctive therapies when provided in conjunction with botulinum neurotoxin (BoNT-A) injection for focal spasticity in adults with neurological conditions.
  
  
  METHODS
  Nine electronic databases.
  
  
  METHODS
  A systematic search was performed to identify randomized, controlled trials (RCTs) evaluating the benefit of adjunctive therapies following BoNT-A injection.
  
  
  METHODS
  Two authors extracted the data independently. Each trial was assessed for internal validity and rated for quality using the PEDro scale. Articles were further appraised using the American Academy of Neurology (AAN) evidence classification to construct concise clinical recommendations.
  
  
  RESULTS
  The search identified 12 studies that reported on the effects of eight different adjunctive therapies following BoNT-A injection in adults with focal spasticity. No high level evidence was identified. The mean PEDro score for the 12 studies was 5.6 (SD = 1.6) and the clinical recommendations provided were Grade U, indicating the effectiveness of the adjunctive therapies was unknown or unproven.
  
  
  CONCLUSIONS
  There was insufficient evidence to support or refute the effectiveness of any of the commonly prescribed adjunctive therapies following BoNT-A injection for focal spasticity in adults.
authors.affiliation: Physiotherapy Department, Epworth Healthcare , Richmond , Australia .
authors.forename: Elizabeth Jane
authors.initials: EJ
authors.lastname: Moore
authors.forename: Megan
authors.initials: M
authors.lastname: Banky
authors.forename: John
authors.initials: J
authors.lastname: Olver
authors.forename: Adam Leigh
authors.initials: AL
authors.lastname: Bryant
authors.forename: Gavin
authors.initials: G
authors.lastname: Williams
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D006801:Humans; D009128:Muscle Spasticity / Q000188:drug therapy*; D009422:Nervous System Diseases / Q000188:drug therapy* / Q000503:physiopathology; D010865:Pilot Projects; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D019274:Botulinum Toxins, Type A; C545476:incobotulinumtoxinA
keywords: Functional status; rehabilitation; stroke; therapy