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CLINICAL PRESENTATION OF PATIENTS WITH LOWER LIMB SPASTICITY UNDER-GOING ROUTINE TREATMENT WITH BOTULINUM TOXIN: BASELINE FINDINGS FROM AN INTERNATIONAL OBSERVATIONAL STUDY

OBJECTIVE: Describe how people with lower limb spasticity present for treatment in routine clinical practice. METHODS: Prospective, observational study (Clinicaltrials.gov: NCT04050527) of ambulatory adult patients (≥ 18 years) with unilateral lower limb spasticity (able to take ≥ 5 steps with or wi...

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Autores principales: ESQUENAZI, Alberto, ZOROWITZ, Richard D., ASHFORD, Stephen, MAISONOBE, Pascal, PAGE, Simon, JACINTO, Jorge
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medical Journals Sweden AB 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10562995/
https://www.ncbi.nlm.nih.gov/pubmed/37794845
http://dx.doi.org/10.2340/jrm.v55.4257
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author ESQUENAZI, Alberto
ZOROWITZ, Richard D.
ASHFORD, Stephen
MAISONOBE, Pascal
PAGE, Simon
JACINTO, Jorge
author_facet ESQUENAZI, Alberto
ZOROWITZ, Richard D.
ASHFORD, Stephen
MAISONOBE, Pascal
PAGE, Simon
JACINTO, Jorge
author_sort ESQUENAZI, Alberto
collection PubMed
description OBJECTIVE: Describe how people with lower limb spasticity present for treatment in routine clinical practice. METHODS: Prospective, observational study (Clinicaltrials.gov: NCT04050527) of ambulatory adult patients (≥ 18 years) with unilateral lower limb spasticity (able to take ≥ 5 steps with or without assistance) presenting for routine spasticity management, including treatment with abobotulinumtoxinA. RESULTS: The study population included 430 adults with lower limb spasticity. Despite their relatively young age (mean ± standard deviation 53.7 ± 13.9 years), only 20% of patients were employed. Most patients had an acquired brain injury due to cerebrovascular disease; 84.1% reported having concomitant upper limb spasticity. Using the Leg Activity Measure, most patients reported no or only mild difficulties in performing hygiene/positioning tasks, while 80.7% had at least mild difficulty with indoor ambulation and 90.5% had at least mild difficulty with walking outdoors. Sensory, communication and/or cognitive impairments were also common. At the first treatment cycle, 50.7% of patients set active function primary goals, including locomotion transferring or standing. CONCLUSION: These observations highlight the complexity of presentation that must be considered when setting treatment goals for lower limb spasticity and emphasize the types of impairment and activity (functional) limitations that treating teams may expect to encounter in their patients and should cover in their initial and follow-up assessments. LAY ABSTRACT Stroke survivors with leg spasticity (an abnormal increase in muscle activity resulting in stiffness of muscle) are often treated with botulinum toxin to reduce the spasticity and enable physical therapy. This paper presents an overview of data from the start of the AboLiSh study, which explores how leg spasticity is managed with abobotulinumtoxinA (a type of botulinum toxin) in everyday practice. Findings from this study (including 384 patients with lower limb spasticity from 9 countries) show the complexity of problems that people with leg spasticity live with. Most stroke survivors were also treated for arm spasticity, and many patients also had significant motor, sensory, communication and cognitive impairments. For stroke survivors who are still able to walk at least 5 steps, the priority treatment goal was to improve their walking, followed by pain management and prevention of contractures (muscle and joint shortening or deformity). All these factors are important for clinicians to consider when agreeing treatment goals with stroke survivors who are living with leg spasticity so that the treatment meets their individual needs.
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spelling pubmed-105629952023-10-11 CLINICAL PRESENTATION OF PATIENTS WITH LOWER LIMB SPASTICITY UNDER-GOING ROUTINE TREATMENT WITH BOTULINUM TOXIN: BASELINE FINDINGS FROM AN INTERNATIONAL OBSERVATIONAL STUDY ESQUENAZI, Alberto ZOROWITZ, Richard D. ASHFORD, Stephen MAISONOBE, Pascal PAGE, Simon JACINTO, Jorge J Rehabil Med Original Report OBJECTIVE: Describe how people with lower limb spasticity present for treatment in routine clinical practice. METHODS: Prospective, observational study (Clinicaltrials.gov: NCT04050527) of ambulatory adult patients (≥ 18 years) with unilateral lower limb spasticity (able to take ≥ 5 steps with or without assistance) presenting for routine spasticity management, including treatment with abobotulinumtoxinA. RESULTS: The study population included 430 adults with lower limb spasticity. Despite their relatively young age (mean ± standard deviation 53.7 ± 13.9 years), only 20% of patients were employed. Most patients had an acquired brain injury due to cerebrovascular disease; 84.1% reported having concomitant upper limb spasticity. Using the Leg Activity Measure, most patients reported no or only mild difficulties in performing hygiene/positioning tasks, while 80.7% had at least mild difficulty with indoor ambulation and 90.5% had at least mild difficulty with walking outdoors. Sensory, communication and/or cognitive impairments were also common. At the first treatment cycle, 50.7% of patients set active function primary goals, including locomotion transferring or standing. CONCLUSION: These observations highlight the complexity of presentation that must be considered when setting treatment goals for lower limb spasticity and emphasize the types of impairment and activity (functional) limitations that treating teams may expect to encounter in their patients and should cover in their initial and follow-up assessments. LAY ABSTRACT Stroke survivors with leg spasticity (an abnormal increase in muscle activity resulting in stiffness of muscle) are often treated with botulinum toxin to reduce the spasticity and enable physical therapy. This paper presents an overview of data from the start of the AboLiSh study, which explores how leg spasticity is managed with abobotulinumtoxinA (a type of botulinum toxin) in everyday practice. Findings from this study (including 384 patients with lower limb spasticity from 9 countries) show the complexity of problems that people with leg spasticity live with. Most stroke survivors were also treated for arm spasticity, and many patients also had significant motor, sensory, communication and cognitive impairments. For stroke survivors who are still able to walk at least 5 steps, the priority treatment goal was to improve their walking, followed by pain management and prevention of contractures (muscle and joint shortening or deformity). All these factors are important for clinicians to consider when agreeing treatment goals with stroke survivors who are living with leg spasticity so that the treatment meets their individual needs. Medical Journals Sweden AB 2023-10-05 /pmc/articles/PMC10562995/ /pubmed/37794845 http://dx.doi.org/10.2340/jrm.v55.4257 Text en © Published by Medical Journals Sweden, on behalf of the Foundation for Rehabilitation Information https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/)
spellingShingle Original Report
ESQUENAZI, Alberto
ZOROWITZ, Richard D.
ASHFORD, Stephen
MAISONOBE, Pascal
PAGE, Simon
JACINTO, Jorge
CLINICAL PRESENTATION OF PATIENTS WITH LOWER LIMB SPASTICITY UNDER-GOING ROUTINE TREATMENT WITH BOTULINUM TOXIN: BASELINE FINDINGS FROM AN INTERNATIONAL OBSERVATIONAL STUDY
title CLINICAL PRESENTATION OF PATIENTS WITH LOWER LIMB SPASTICITY UNDER-GOING ROUTINE TREATMENT WITH BOTULINUM TOXIN: BASELINE FINDINGS FROM AN INTERNATIONAL OBSERVATIONAL STUDY
title_full CLINICAL PRESENTATION OF PATIENTS WITH LOWER LIMB SPASTICITY UNDER-GOING ROUTINE TREATMENT WITH BOTULINUM TOXIN: BASELINE FINDINGS FROM AN INTERNATIONAL OBSERVATIONAL STUDY
title_fullStr CLINICAL PRESENTATION OF PATIENTS WITH LOWER LIMB SPASTICITY UNDER-GOING ROUTINE TREATMENT WITH BOTULINUM TOXIN: BASELINE FINDINGS FROM AN INTERNATIONAL OBSERVATIONAL STUDY
title_full_unstemmed CLINICAL PRESENTATION OF PATIENTS WITH LOWER LIMB SPASTICITY UNDER-GOING ROUTINE TREATMENT WITH BOTULINUM TOXIN: BASELINE FINDINGS FROM AN INTERNATIONAL OBSERVATIONAL STUDY
title_short CLINICAL PRESENTATION OF PATIENTS WITH LOWER LIMB SPASTICITY UNDER-GOING ROUTINE TREATMENT WITH BOTULINUM TOXIN: BASELINE FINDINGS FROM AN INTERNATIONAL OBSERVATIONAL STUDY
title_sort clinical presentation of patients with lower limb spasticity under-going routine treatment with botulinum toxin: baseline findings from an international observational study
topic Original Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10562995/
https://www.ncbi.nlm.nih.gov/pubmed/37794845
http://dx.doi.org/10.2340/jrm.v55.4257
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