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Salga M, Gatin L, Deltombe T, Gustin T, Carda S, Marque P, Winston P, Reebye R, Wein T, Esquenazi A, Keenan MA, Molteni F, Zerbinati P, Picelli A, Coroian F, Coulet B, Sturbois-Nachef N, Fontaine C, Yelnik A, Parratte B, Henry P, Venkatakrishnan S, Rigoard P, David R, Denormandie P, Schnitzler A, Allart E, Genet F. International Recommendations to Manage Poststroke Equinovarus Foot Deformity Validated by a Panel of Experts Using Delphi. Arch Phys Med Rehabil 2023; 104:372-379. [PMID: 36030892 DOI: 10.1016/j.apmr.2022.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/27/2022] [Accepted: 07/30/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To establish international recommendations for the management of spastic equinovarus foot deformity. DESIGN Delphi method. SETTING International study. PARTICIPANTS A total of 24 international experts (N=24) in neuro-orthopedic deformities, from different specialties (Physical and Rehabilitation Medicine physicians, neurologists, geriatricians, orthopedic surgeons, neurosurgeons, plastic surgeons). INTERVENTIONS Experts answered 3 rounds of questions related to important aspects of diagnosis, assessment, and treatment of spastic equinovarus foot deformity. MAIN OUTCOME MEASURES A consensus was established when at least 80% of experts agreed on a statement RESULTS: A total of 52 items reached consensus. Experts recommend assessing effect of the deformity on functional activities before treatment. Before treatment, it is crucial to differentiate spastic muscle overactivity from soft tissue contractures, identify which muscles are involved in the deformity, and evaluate the activity of antagonist muscles. Motor nerve blocks, 2-dimensional video analysis, and radiologic examinations are often required to complement a clinical examination. The treatment of equinovarus foot depends on the correctability of the deformity and the patient's ability to stand or walk. The preoperative assessment should include an interdisciplinary consultation that must finalize a formal agreement between physicians and the patient, which will define personalized attainable goals before surgery. CONCLUSION The establishment of guidelines on managing equinovarus foot will help physicians and surgeons, specialists, and nonspecialists to diagnoses and assess the deformity and direct patients to a network of experts to optimize patient functional recovery and improve their autonomy.
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Affiliation(s)
- Marjorie Salga
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ), UFR Simone Veil - Santé, Montigny-le-Bretonneux, France; Garches Neuro-Orthopaedics Research Group (GRENOG), Garches, France
| | - Laure Gatin
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ), UFR Simone Veil - Santé, Montigny-le-Bretonneux, France; Garches Neuro-Orthopaedics Research Group (GRENOG), Garches, France; Department of Orthopaedic Surgery, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Thierry Deltombe
- Department of Physical Medicine and Rehabilitation, CHU UCL Namur site Godinne, Yvoir, Belgium; Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, Ontario, Canada
| | - Thierry Gustin
- Department of Neurosurgery, CHU UCL Namur site Godinne, Yvoir, Belgium
| | - Stefano Carda
- Service of Neuropsychology and Neurorehabilitation, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Marque
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France; Department of Neurological Rehabilitation, University Hospital of Toulouse, Hôpital de Rangueil, Toulouse, France
| | - Paul Winston
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, Ontario, Canada; Division of Physical Medicine and Rehabilitation, University of British Columbia, Victoria, British Columbia, Canada
| | - Rajiv Reebye
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Theodore Wein
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Alberto Esquenazi
- MossRehab and Albert Einstein Medical Center, Elkins Park, Pennsylvania
| | - Mary-Ann Keenan
- Penn Neuro-Orthopaedics Service, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Italy
| | - Paolo Zerbinati
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy; U.O. Neuroortopedia, Ospedale Santa Maria Multimedica Castellanza, Varese, Italy
| | - Alessandro Picelli
- Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Center, University of Verona, Verona, Italy
| | - Flavia Coroian
- Physical and Rehabilitation Medicine Department, Montpellier University Hospital, Montpellier, France; Euromov, Montpellier University, Montpellier, France
| | - Bertrand Coulet
- Hand and Upper Limb Surgery Department, CHRU Lapeyronie, Montpellier, France
| | - Nadine Sturbois-Nachef
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, Ontario, Canada; Department of Orthopedic Surgery, Lille University Medical Center, Lille, France
| | - Christian Fontaine
- Department of Orthopedic Surgery, Lille University Medical Center, Lille, France
| | - Alain Yelnik
- Department of Physical and Rehabilitation Medicine, Université de Paris, AP-HP Hospital Fernand Widal, Paris, France
| | - Bernard Parratte
- Department of Physical and Rehabilitation Medicine, CHRU Jean Minjoz, Besançon-Franche-Comté University, Besançon, France
| | - Prakash Henry
- Department of Neurological Rehabilitation, Christian Medical College, Vellore, India
| | | | - Philippe Rigoard
- Institut Pprime CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France; Spine and Neuromodulation Functional Unit, Department of Neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France
| | - Romain David
- Department of Physical and Rehabilitation Medicine, University Hospital Center of Poitiers, PRISMATICS Lab, Poitiers, France
| | - Philippe Denormandie
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Department of Orthopaedic Surgery, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Alexis Schnitzler
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Etienne Allart
- Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Neurorehabilitation Unit, Lille, France
| | - François Genet
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ), UFR Simone Veil - Santé, Montigny-le-Bretonneux, France; Garches Neuro-Orthopaedics Research Group (GRENOG), Garches, France.
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Allart E, Sturbois-Nachef N, Salga M, Rosselin C, Gatin L, Genêt F. Neuro-Orthopedic Surgery for Equinovarus Foot Deformity in Adults: A Narrative Review. J Foot Ankle Surg 2022; 61:648-656. [PMID: 34953669 DOI: 10.1053/j.jfas.2021.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 02/03/2023]
Abstract
Neuro-orthopedic surgery is an alternative to the conservative treatment of spastic equinovarus foot (SEF) in adults. The objective of the present narrative review was to summarize current practice with regard to patient assessment, the choice of treatment, the various neuro-orthopedic procedures, and the latter's outcomes. We searched literature databases (MEDLINE, EMBASE, Cochrane) for original articles or opinion papers on surgical treatment of spastic equinovarus foot in adults. Neuro-orthopedic approaches require a careful analysis of the patient's and/or his/her caregiver needs and thus relevant treatment goals. Surgical planning requires detailed knowledge of impairments involved in the spastic equinovarus foot deformity based on a careful clinical examination and additional information from diagnostic nerve blocks and/or a quantitative gait analysis. Procedures mainly target nerves (neurotomy) and tendons (lengthening, transfer, tenotomy). These procedures reduce impairments (spasticity, range of motion, and foot position), improve gait and walking function, but their impact on participation and personalized treatment goals remains to be demonstrated. Neuro-orthopedic surgery is an effective treatment option for spastic equinovarus foot in adults. However, practice is still very heterogeneous and there is no consensus on the medical strategies to be applied before, during and after surgery (particularly the type of anesthesia, the need for immobilization, rehabilitation procedures).
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Affiliation(s)
- Etienne Allart
- CHU Lille, Neurorehabilitation Unit, Lille, France; Univ. Lille, INSERM UMR1172-Lille Neuroscience and Cognition, Lille, France.
| | - Nadine Sturbois-Nachef
- CHU Lille, Department of Orthopedic Surgery, Lille, France; Univ. Lille, EA 7369-URePSSS, Lille, France
| | - Marjorie Salga
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), PMR Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ); UFR Simone Veil - Santé, END: ICAP, Inserm U1179, Montigny-le-Bretonneux, France; Garches Neuro-Orthopedics Research Group (GRENOG), Garches, France
| | | | - Laure Gatin
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), PMR Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ); UFR Simone Veil - Santé, END: ICAP, Inserm U1179, Montigny-le-Bretonneux, France; Garches Neuro-Orthopedics Research Group (GRENOG), Garches, France; Department of Orthopedic Surgery, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - François Genêt
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), PMR Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ); UFR Simone Veil - Santé, END: ICAP, Inserm U1179, Montigny-le-Bretonneux, France; Garches Neuro-Orthopedics Research Group (GRENOG), Garches, France
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Esquenazi A, Francisco GE, Feng W, Baricich A, Gallien P, Fanning K, Zuzek A, Bandari DS, Wittenberg GF. Real-World Adherence to OnabotulinumtoxinA Treatment for Spasticity: Insights From the ASPIRE Study. Arch Phys Med Rehabil 2021; 102:2172-2184.e6. [PMID: 34245684 DOI: 10.1016/j.apmr.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/19/2021] [Accepted: 06/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To identify baseline characteristics and treatment-related variables that affect adherence to onabotulinumtoxinA treatment from the Adult Spasticity International Registry (ASPIRE) study. DESIGN Prospective, observational registry (NCT01930786). SETTING International clinical sites. PARTICIPANTS Adults with spasticity (N=730). INTERVENTIONS OnabotulinumtoxinA at clinician's discretion. MAIN OUTCOME MEASURES Clinically meaningful thresholds used for treatment adherent (≥3 treatment sessions during 2-year study) and nonadherent (≤2 sessions). Data analyzed using logistic regression and presented as odds ratios (ORs) with 95% confidence intervals (CIs). Treatment-related variables assessed at sessions 1 and 2 only. RESULTS Of the total population, 523 patients (71.6%) were treatment adherent with 5.3±1.6 sessions and 207 (28.4%) were nonadherent with 1.5±0.5 sessions. In the final model (n=626/730), 522 patients (83.4%) were treatment adherent and 104 (16.6%) were nonadherent. Baseline characteristics associated with adherence: treated in Europe (OR=1.84; CI, 1.06-3.21; P=.030) and use of orthotics (OR=1.88; CI, 1.15-3.08; P=.012). Baseline characteristics associated with nonadherence: history of diplopia (OR=0.28; CI, 0.09-0.89; P=.031) and use of assistive devices (OR=0.51; CI, 0.29-0.90; P=.021). Treatment-related variables associated with nonadherence: treatment interval ≥15 weeks (OR=0.43; CI, 0.26-0.72; P=.001) and clinician dissatisfaction with onabotulinumtoxinA to manage pain (OR=0.18; CI, 0.05-0.69; P=.012). Of the population with stroke (n=411), 288 patients (70.1%) were treatment adherent with 5.3±1.6 sessions and 123 (29.9%) were nonadherent with 1.5±0.5 session. In the final stroke model (n=346/411), 288 patients (83.2%) were treatment adherent and 58 (16.8%) were nonadherent. Baseline characteristics associated with adherence: treated in Europe (OR=2.99; CI, 1.39-6.44; P=.005) and use of orthotics (OR=3.18; CI, 1.57-6.45; P=.001). Treatment-related variables associated with nonadherence: treatment interval ≥15 weeks (OR=0.42; CI, 0.21-0.83; P=.013) and moderate/severe disability on upper limb Disability Assessment Scale pain subscale (OR=0.40; CI, 0.19-0.83; P=.015). CONCLUSIONS These ASPIRE analyses demonstrate real-world patient and clinical variables that affect adherence to onabotulinumtoxinA and provide insights to help optimize management strategies to improve patient care.
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Affiliation(s)
| | - Gerard E Francisco
- University of Texas Health Science Center McGovern Medical School and TIRR Memorial Hermann, Houston, TX
| | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC
| | - Alessio Baricich
- Physical and Rehabilitation Medicine, Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Philippe Gallien
- Physical Medicine and Rehabilitation, Pôle MPR Saint Hélier, Rennes, France
| | | | - Aleksej Zuzek
- Medical Affairs, Spasticity and Movement Disorders/Urology, Allergan, an AbbVie Company, Irvine, CA
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