Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/113720
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Type: Journal article
Title: A systematic review: efficacy of botulinum toxin in walking and quality of life in post-stroke lower limb spasticity
Author: Gupta, A.D.
Chu, W.H.
Howell, S.
Chakraborty, S.
Koblar, S.
Visvanathan, R.
Cameron, I.
Wilson, D.
Citation: Systematic reviews, 2018; 7(1):1
Publisher: BMC
Issue Date: 2018
ISSN: 2046-4053
2046-4053
Statement of
Responsibility: 
Anupam Datta Gupta, Wing Hong Chu, Stuart Howell, Subhojit Chakraborty, Simon Koblar, Renuka Visvanathan, Ian Cameron and David Wilson
Abstract: Improved walking is one of the highest priorities in people living with stroke. Post-stroke lower limb spasticity (PSLLS) impedes walking and quality of life (QOL). The understanding of the evidence of improved walking and QOL following botulinum toxin (BoNTA) injection is not clear. We performed a systematic review of the randomized control trials (RCT) to evaluate the effectiveness of BoNTA injection on walking and QOL in PSLLS.We searched PubMed, Web of Science, Embase, CINAHL, ProQuest Thesis and Dissertation checks, Google Scholar, WHO International Clinical Trial Registry Platform, ClinicalTrials.gov , Cochrane, and ANZ and EU Clinical Trials Register for RCTs looking at improvement in walking and QOL following injection of BoNTA in PSLLS. The original search was carried out prior to 16 September 2015. We conducted an additional verifying search on CINHAL, EMBASE, and MEDLINE (via PubMed) from 16 September 2015 to 6 June 2017 using the same clauses as the previous search. Methodological quality of the individual studies was critically appraised using Joanna Briggs Institute's instrument. Only placebo-controlled RCTs looking at improvement in walking and QOL were included in the review.Of 2026 records, we found 107 full-text records. Amongst them, we found five RCTs qualifying our criteria. No new trials were found from the verifying search. Two independent reviewers assessed methodological validity prior to inclusion in the review using Joanna Briggs Institute's appraisal instrument. Two studies reported significant improvement in gait velocity (p = 0.020) and < 0.05, respectively. One study showed significant improvement in 2-min-walking distance (p < 0.05). QOL was recorded in one study without any significant improvement. Meta-analysis of reviewed studies could not be performed because of different methods of assessing walking ability, small sample size with large confidence interval and issues such as lack of power calculations in some studies. Findings from our systematic and detailed study identify the need for a well-designed RCT to adequately investigate the issues highlighted.This review could not conclude there was sufficient evidence to support or refute improvement on walking or QOL following BoNTA injection. Reasons for this are discussed, and methods for future RCTs are developed.
Keywords: Botulinum toxin; Lower limb; Spasticity; Stroke
Rights: © The Author(s). 2018. By submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. Please note that comments may be removed without notice if they are flagged by another user or do not comply with our community guidelines.
RMID: 0030080132
DOI: 10.1186/s13643-017-0670-9
Appears in Collections:Public Health publications

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