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Constraint-Induced Movement Therapy Combined With Botulinum Toxin for Post-stroke Spasticity: A Systematic Review and Meta-Analysis

Stroke is considered one of the main causes of adult disability and the second most serious cause of death worldwide. The combination of botulinum toxin type A (BTX) with rehabilitation techniques such as modified constraint-induced movement therapy (mCIMT) has emerged as a highly efficient interven...

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Autores principales: Nasb, Mohammad, Shah, Sayed Zulfiqar Ali, Chen, Hong, Youssef, Ahmed S, Li, Zhenlan, Dayoub, Lamis, Noufal, Abdullah, Allam, Abdallah El Sayed, Hassanien, Manal, El Oumri, Ahmed Amine, Chang, Ke-Vin, Wu, Wei-Ting, Rekatsina, Martina, Galluccio, Felice, AlKhrabsheh, Abdullah, Salti, Ammar, Varrassi, Giustino
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8486367/
https://www.ncbi.nlm.nih.gov/pubmed/34646693
http://dx.doi.org/10.7759/cureus.17645
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author Nasb, Mohammad
Shah, Sayed Zulfiqar Ali
Chen, Hong
Youssef, Ahmed S
Li, Zhenlan
Dayoub, Lamis
Noufal, Abdullah
Allam, Abdallah El Sayed
Hassanien, Manal
El Oumri, Ahmed Amine
Chang, Ke-Vin
Wu, Wei-Ting
Rekatsina, Martina
Galluccio, Felice
AlKhrabsheh, Abdullah
Salti, Ammar
Varrassi, Giustino
author_facet Nasb, Mohammad
Shah, Sayed Zulfiqar Ali
Chen, Hong
Youssef, Ahmed S
Li, Zhenlan
Dayoub, Lamis
Noufal, Abdullah
Allam, Abdallah El Sayed
Hassanien, Manal
El Oumri, Ahmed Amine
Chang, Ke-Vin
Wu, Wei-Ting
Rekatsina, Martina
Galluccio, Felice
AlKhrabsheh, Abdullah
Salti, Ammar
Varrassi, Giustino
author_sort Nasb, Mohammad
collection PubMed
description Stroke is considered one of the main causes of adult disability and the second most serious cause of death worldwide. The combination of botulinum toxin type A (BTX) with rehabilitation techniques such as modified constraint-induced movement therapy (mCIMT) has emerged as a highly efficient intervention for stroke patients to start synchronized motor function along with spasticity reduction. The current systematic review and meta-analysis were conducted in order to evaluate the available literature about the safety and efficacy of constraint-induced movement therapy (CIMT) combined with BTX in stroke patients with upper limb spasticity. Searches were conducted on WoS (Web of Science), Ovid, EBSCO-ASC&BSC, and PubMed for identifying relevant literature published from 2000-2020. Randomized Controlled Trials (RCTs) and Quasi-experimental studies were considered for inclusion. Rayyan (systematic review tool) QCRI (Qatar Computing Research Institute) was used for independent screening of the studies by two reviewers. For risk of bias and study quality assessment, Cochrane risk of bias tool (RoB 2) and Physiotherapy Evidence Database (PEDro) scales were used. Cochrane review manager was used to carry out the meta-analyses of the included studies. The search resulted in a total of 13065 references, of which 4967 were duplicates. After the title, abstract and full-text screening, two RCTs were deemed eligible for inclusion. Both the RCTs scored 8 on PEDro and were level evidence. The studies were heterogeneous. The findings of this meta-analysis in all the three joints post-stroke spasticity assessed on modified Ashworth scale (MAS) at four weeks post-injection aren’t statistically significant (elbow P-value 0.74, wrist P-value 0.57, fingers P-value 0.42), however, according to one of the included studies the therapeutic efficacy of the combination of BTX-mCIMT injection assessed at four weeks post-injection in wrist and finger flexors was promising.  The effectiveness of BTX-CIMT combination over conventional therapy (CT) for improving post-stroke spasticity still needs to be explored with long-term, multicenter rigorously designed RCTs having a good sample size. However, the BTX-CIMT combination is promising for enhancing motor function recovery and improving activities of daily living (ADLs).
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spelling pubmed-84863672021-10-12 Constraint-Induced Movement Therapy Combined With Botulinum Toxin for Post-stroke Spasticity: A Systematic Review and Meta-Analysis Nasb, Mohammad Shah, Sayed Zulfiqar Ali Chen, Hong Youssef, Ahmed S Li, Zhenlan Dayoub, Lamis Noufal, Abdullah Allam, Abdallah El Sayed Hassanien, Manal El Oumri, Ahmed Amine Chang, Ke-Vin Wu, Wei-Ting Rekatsina, Martina Galluccio, Felice AlKhrabsheh, Abdullah Salti, Ammar Varrassi, Giustino Cureus Neurology Stroke is considered one of the main causes of adult disability and the second most serious cause of death worldwide. The combination of botulinum toxin type A (BTX) with rehabilitation techniques such as modified constraint-induced movement therapy (mCIMT) has emerged as a highly efficient intervention for stroke patients to start synchronized motor function along with spasticity reduction. The current systematic review and meta-analysis were conducted in order to evaluate the available literature about the safety and efficacy of constraint-induced movement therapy (CIMT) combined with BTX in stroke patients with upper limb spasticity. Searches were conducted on WoS (Web of Science), Ovid, EBSCO-ASC&BSC, and PubMed for identifying relevant literature published from 2000-2020. Randomized Controlled Trials (RCTs) and Quasi-experimental studies were considered for inclusion. Rayyan (systematic review tool) QCRI (Qatar Computing Research Institute) was used for independent screening of the studies by two reviewers. For risk of bias and study quality assessment, Cochrane risk of bias tool (RoB 2) and Physiotherapy Evidence Database (PEDro) scales were used. Cochrane review manager was used to carry out the meta-analyses of the included studies. The search resulted in a total of 13065 references, of which 4967 were duplicates. After the title, abstract and full-text screening, two RCTs were deemed eligible for inclusion. Both the RCTs scored 8 on PEDro and were level evidence. The studies were heterogeneous. The findings of this meta-analysis in all the three joints post-stroke spasticity assessed on modified Ashworth scale (MAS) at four weeks post-injection aren’t statistically significant (elbow P-value 0.74, wrist P-value 0.57, fingers P-value 0.42), however, according to one of the included studies the therapeutic efficacy of the combination of BTX-mCIMT injection assessed at four weeks post-injection in wrist and finger flexors was promising.  The effectiveness of BTX-CIMT combination over conventional therapy (CT) for improving post-stroke spasticity still needs to be explored with long-term, multicenter rigorously designed RCTs having a good sample size. However, the BTX-CIMT combination is promising for enhancing motor function recovery and improving activities of daily living (ADLs). Cureus 2021-09-01 /pmc/articles/PMC8486367/ /pubmed/34646693 http://dx.doi.org/10.7759/cureus.17645 Text en Copyright © 2021, Nasb et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Neurology
Nasb, Mohammad
Shah, Sayed Zulfiqar Ali
Chen, Hong
Youssef, Ahmed S
Li, Zhenlan
Dayoub, Lamis
Noufal, Abdullah
Allam, Abdallah El Sayed
Hassanien, Manal
El Oumri, Ahmed Amine
Chang, Ke-Vin
Wu, Wei-Ting
Rekatsina, Martina
Galluccio, Felice
AlKhrabsheh, Abdullah
Salti, Ammar
Varrassi, Giustino
Constraint-Induced Movement Therapy Combined With Botulinum Toxin for Post-stroke Spasticity: A Systematic Review and Meta-Analysis
title Constraint-Induced Movement Therapy Combined With Botulinum Toxin for Post-stroke Spasticity: A Systematic Review and Meta-Analysis
title_full Constraint-Induced Movement Therapy Combined With Botulinum Toxin for Post-stroke Spasticity: A Systematic Review and Meta-Analysis
title_fullStr Constraint-Induced Movement Therapy Combined With Botulinum Toxin for Post-stroke Spasticity: A Systematic Review and Meta-Analysis
title_full_unstemmed Constraint-Induced Movement Therapy Combined With Botulinum Toxin for Post-stroke Spasticity: A Systematic Review and Meta-Analysis
title_short Constraint-Induced Movement Therapy Combined With Botulinum Toxin for Post-stroke Spasticity: A Systematic Review and Meta-Analysis
title_sort constraint-induced movement therapy combined with botulinum toxin for post-stroke spasticity: a systematic review and meta-analysis
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8486367/
https://www.ncbi.nlm.nih.gov/pubmed/34646693
http://dx.doi.org/10.7759/cureus.17645
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