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Kumar P, Christodoulou A, Loizou M. Assessment approaches for hemiplegic shoulder pain in people living with stroke - A scoping review. Disabil Rehabil 2024:1-11. [PMID: 39105542 DOI: 10.1080/09638288.2024.2385736] [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: 01/11/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE Hemiplegic shoulder pain (HSP) is reported in up to 40% of people with stroke. Causes of HSP are often multifactorial. To inform appropriate treatment, reliable/valid assessments are critical. The aim of this scoping review was to collate assessment approaches used in studies where the primary outcome was HSP, and to identify how frequently each assessment approach was used. METHODS A systematic search, including studies from 2000-2023 was conducted of the MEDLINE, EMBASE, CINAHL, AMED, Biomed Central, and Cochrane Library databases, with four key terms used: "assess", "stroke", "pain" and "shoulder". All primary studies published in English language fulfilling the reviews inclusion criteria were included. Six reviewers extracted the data. RESULTS A total of 29 assessment methods for HSP were identified from 124 studies. The common assessments were: Visual Analogue Scale (n = 75, 60%), Passive Range of Movement (n = 65, 52%), Fugl-Meyer Assessment (n = 32, 26%), glenohumeral subluxation (n = 30, 24%) and Numerical Rating Scale (n = 27, 22%). CONCLUSION A wide range of assessment approaches was identified for HSP, and some are used more than others. A fully comprehensive assessment that considers different aspects of pain including severity and timing, functioning, and the psychological burden, is needed in this area of practice to be able to guide appropriate treatment.
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Affiliation(s)
- Praveen Kumar
- College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Avgi Christodoulou
- College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Michael Loizou
- Centre for Health Technology, University of Plymouth, Plymouth, UK
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Săndulescu MI, Cinteză D, Poenaru D, Potcovaru CG, Păunescu H, Coman OA. The Complex Role of Botulinum Toxin in Enhancing Goal Achievement for Post-Stroke Patients. Toxins (Basel) 2024; 16:172. [PMID: 38668597 PMCID: PMC11054582 DOI: 10.3390/toxins16040172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 04/29/2024] Open
Abstract
INTRODUCTION The rehabilitation medical team is responsible for the therapeutic management of post-stroke patients and, therefore, for the complex therapeutic approach of spasticity. Considering the generous arsenal at our disposal in terms of both pharmacological treatment, through the possibility of administering botulinum toxin to combat spasticity, and in terms of accurate assessment through developed functional scales such as the GAS (Goal Attainment Scale), one of our purposes is to monitor the parameters that influence the achievement of functional goals set by patients together with the medical team in order to render the patients as close as possible to achieving their proposed functional goals, thus enhancing their quality of life. By assessing and establishing statistical and clinical correlations between the GAS and quantifiable parameters related to the affected post-stroke upper limb, namely degree of spasticity, motor control, pain level and evolution of pain under treatment with BoNT-A (abobotulinum toxin A), and patients' overall response to BoNT-A treatment, we aim to quantify the improvement of the therapeutic management of post-stroke patients with spasticity and develop a more personalized and effective approach to their disability and impairment. RESULTS AND DISCUSSIONS The analysis concluded that there were two independent predictors of the Achieved GAS-T score (the study's endpoint parameter) motor control at any level of the upper limb and number of prior BoNT-A injections. The number of prior BoNT-A injections was an independent predictor of Achieved GAS-T score improvement but had no significant influence over Baseline GAS-T score. Enhancement in proximal and intermediate motor control showed a GAS score improvement of 3.3 points and a 0.93-point GAS score improvement for wrist motor control progress. From a separate viewpoint, patients with motor deficit on the left side have shown significantly greater improvement in Changed GAS-T scores by 2.5 points compared to patients with deficits on the right side; however, we note as a study limitation the fact that there was no statistical analysis over the dominant cerebral hemisphere of each patient. CONCLUSIONS Improvement in the Achieved GAS-T score means better achievement of patients' goals. Thus, after the BoNT- A intervention, at follow-up evaluation, GAS was found to be directly correlated with improvement in motor control of the affected upper limb. Mobility of the corresponding limb was enhanced by pain decrease during p-ROM (passive range of motion) and by amelioration of spasticity. MATERIALS AND METHODS We conducted an observational, non-randomized clinical study on 52 stroke patients, a representative sample of patients with post-stroke spasticity and disability from our neurological rehabilitation clinic, who have been treated and undergone a specific rehabilitation program in our tertiary diagnostic and treatment medical center, including BoNT-A focal treatment for spasticity in the affected upper limb. The primary objective of the study was to assess the influence of abobotulinum toxin A treatment on the Goal Attainment Scale. Secondary objectives of the study included the assessment of BoNT-A treatment efficacy on spasticity with the MAS (Modified Ashworth Scale), pain with the NRS (Numerical Rating Scale), and joint passive range of motion (p-ROM), identifying demographic, clinical, and pharmacological factors that influence the response to BoNT-A treatment, as well as to conduct a descriptive and exploratory analysis of the studied variables.
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Affiliation(s)
- Miruna Ioana Săndulescu
- Doctoral School, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.P.); (H.P.); (O.A.C.)
- Rehabilitation Department 9, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pharmacology and Pharmacotherapy, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- National Institute of Rehabilitation, Physical Medicine and Balneo-Climatology, 010024 Bucharest, Romania
| | - Delia Cinteză
- Doctoral School, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.P.); (H.P.); (O.A.C.)
- Rehabilitation Department 9, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- National Institute of Rehabilitation, Physical Medicine and Balneo-Climatology, 010024 Bucharest, Romania
| | - Daniela Poenaru
- Doctoral School, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.P.); (H.P.); (O.A.C.)
- Rehabilitation Department 9, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- National Institute of Rehabilitation, Physical Medicine and Balneo-Climatology, 010024 Bucharest, Romania
| | - Claudia-Gabriela Potcovaru
- Doctoral School, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.P.); (H.P.); (O.A.C.)
- Rehabilitation Department 9, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- National Institute of Rehabilitation, Physical Medicine and Balneo-Climatology, 010024 Bucharest, Romania
| | - Horia Păunescu
- Doctoral School, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.P.); (H.P.); (O.A.C.)
- Rehabilitation Department 9, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pharmacology and Pharmacotherapy, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- National Institute of Rehabilitation, Physical Medicine and Balneo-Climatology, 010024 Bucharest, Romania
| | - Oana Andreia Coman
- Doctoral School, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.P.); (H.P.); (O.A.C.)
- Department of Pharmacology and Pharmacotherapy, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Struyf P, Triccas LT, Schillebeeckx F, Struyf F. The Place of Botulinum Toxin in Spastic Hemiplegic Shoulder Pain after Stroke: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2797. [PMID: 36833493 PMCID: PMC9957016 DOI: 10.3390/ijerph20042797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/19/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Stroke is a common pathology worldwide, with an age-standardized global rate of new strokes of 150.5 per 100,000 population in 2017. Stroke causes upper motor neuron impairment leading to a spectrum of muscle weakness around the shoulder joint, changes in muscle tone, and subsequent soft tissue changes. Hemiplegic shoulder pain (HSP) is the most common pain condition in stroke patients and one of the four most common medical complications after stroke. The importance of the appropriate positioning and handling of the hemiplegic shoulder for prevention of HSP is therefore of high clinical relevance. Nevertheless, HSP remains a frequent and disabling problem after stroke, with a 1-year prevalence rate up to 39%. Furthermore, the severity of the motor impairment is one of the most important identified risk factors for HSP in literature. Spasticity is one of these motor impairments that is likely to be modifiable. After ruling out or treating other shoulder pathologies, spasticity must be assessed and treated because it could lead to a cascade of unwanted complications, including spastic HSP. In clinical practice, Botulinum toxin A (BTA) is regarded as the first-choice treatment of focal spasticity in the upper limb, as it gives the opportunity to target specifically selected muscles. It thereby provides the possibility of a unique patient tailored focal and reversible treatment for post stroke spasticity. This scoping review aims to summarize the current evidence of BTA treatment for spastic HSP. First, the clinical manifestation and outcome measures of spastic HSP will be addressed, and second the current evidence of BTA treatment of spastic HSP will be reviewed. We also go in-depth into the elements of BTA application that may optimize the therapeutic effect of BTA. Finally, future considerations for the use of BTA for spastic HSP in clinical practice and research settings will be discussed.
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Affiliation(s)
- Pieter Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, B-2610 Wilrijk, Belgium
- Department of Rehabilitation Medicine, Research School Caphri, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands
- Adelante Zorggroep, 6229 HX Maastricht, The Netherlands
| | - Lisa Tedesco Triccas
- REVAL, Faculty of Rehabilitation Sciences, Universiteit Hasselt, B-3590 Diepenbeek, Belgium
- Department of Clinical and Movement Neuroscience, Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Fabienne Schillebeeckx
- Department of Physical Medicine and Rehabilitation, University Hospital Leuven, B-3000 Leuven, Belgium
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, B-2610 Wilrijk, Belgium
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Kassam F, Lim B, Afroz S, Boissonnault È, Reebye R, Finlayson H, Winston P. Canadian Physicians' Use of Intramuscular Botulinum Toxin Injections for Shoulder Spasticity: A National Cross-Sectional Survey. Toxins (Basel) 2023; 15:58. [PMID: 36668878 PMCID: PMC9866374 DOI: 10.3390/toxins15010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/12/2023] Open
Abstract
Spasticity of the upper extremity can result in severe pain, along with many complications that can impair a patient's activities of daily living. Failure to treat patients with spasticity of the upper limb can result in a decrease in the range of motion of joints and contracture development, leading to further restriction in daily activities. We aimed to investigate the practice patterns of Canadian physicians who utilize Botulinum toxin type-A (BoNT-A) injections in the management of shoulder spasticity. 50 Canadian Physical Medicine and Rehabilitation (PM&R) physicians completed a survey with an estimated completion rate of (36.23%). The demographics of the survey participants came from a variety of provinces, clinical settings, and patient populations. The most common muscle injected for shoulder adduction and internal rotation spasticity was the pectoralis major, this was followed by latissimus dorsi, pectoralis minor, subscapularis and teres major. Injection of BoNT-A for problematic post-stroke shoulder spasticity was common, with (81.48%) of participants responding that it was always or often used in their management of post-stroke spasticity (PSS). Dosing of BoNT-A demonstrated variability for the muscle injected as well as the type of toxin used. The goals of the patients, caregivers, and practitioners were used to help guide the management of these patients. As a result, the practice patterns of Canadian physicians who treat shoulder spasticity are varied, due to numerous patient factors. Future studies are needed to analyze optimal treatment patterns, and the development of algorithms to standardize care.
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Affiliation(s)
- Farris Kassam
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z7, Canada
| | - Brendan Lim
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z7, Canada
| | - Sadia Afroz
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z7, Canada
| | - Ève Boissonnault
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z7, Canada
- Division of Physical Medicine and Rehabilitation, Université de Montréal, Montreal, QC H3S 2J4, Canada
| | - Rajiv Reebye
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z7, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 2G9, Canada
- GF Strong Rehabilitation Center, Vancouver, BC V5Z 2G9, Canada
| | - Heather Finlayson
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z7, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 2G9, Canada
- GF Strong Rehabilitation Center, Vancouver, BC V5Z 2G9, Canada
| | - Paul Winston
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z7, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 2G9, Canada
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Kumar P, Fernando C, Mendoza D, Shah R. Risk and associated factors for hemiplegic shoulder pain in people with stroke: a systematic literature review. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.2019369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Praveen Kumar
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Chiara Fernando
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Deanna Mendoza
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Riya Shah
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
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Li Y, Wang M, Tang S, Zhu X, Yang S. Localization of nerve entry points and the center of intramuscular nerve-dense regions in the adult pectoralis major and pectoralis minor and its significance in blocking muscle spasticity. J Anat 2021; 239:1123-1133. [PMID: 34176122 PMCID: PMC8546509 DOI: 10.1111/joa.13493] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/03/2021] [Accepted: 06/09/2021] [Indexed: 11/27/2022] Open
Abstract
The aims of this study were to localize the body surface position and depth of nerve entry points, and the center of the intramuscular nerve-dense regions of the pectoralis major and pectoralis minor in order to provide guidance for blocking muscle spasticity. Formalin-fixed adult cadavers (66.3 ± 5.2 years) were used. The curved line on the skin from the acromion to the most inferior point of the jugular notch was defined as the horizontal reference line (H). The line from the most inferior point of the jugular notch to the xiphisternal joint was defined as the longitudinal reference line (L). The nerve entry points was anatomically exposed. Sihler's staining, barium sulfate labeling, and computed tomography were employed to determine the projection points (P) on the body surface. The intersection of the longitudinal line through the P point and the H line and the horizontal line through the P point and the L line were recorded as PH and PL , respectively. The projection of the nerve entry points or the center of the intramuscular nerve-dense regions were in the opposite direction across the transverse plane and were recorded as P'. The percentage positions of PH and PL on the H and L lines, as well as the nerve entry points and the center of the intramuscular nerve-dense regions depths, were determined using the Syngo system. The pectoralis major had two nerve entry points, while the pectoralis minor had only one. In addition, two intramuscular nerve-dense regions were found in the pectoralis major, while only one region was found in the pectoralis minor. The PH of the nerve entry points were located at 47.83%, 32.31%, and 34.31%, while the PH of the center of the intramuscular nerve-dense regions were at 41.95%, 55.88%, and 32.58% of line H, respectively. The PL of the nerve entry points were at -9.84%, 36.16%, and 2.44%, while the PL for each of three center of the intramuscular nerve-dense regions was at -3.87%, 25.29%, and -7.13% of line L, respectively. The depth for each of the nerve entry points was at 17.76%, 17.53%, and 25.51% of line P-P'', respectively, and the depth of the center of the intramuscular nerve-dense regions was at 5.23%, 6.75%, and 13.73% of line P-P', respectively. These percentage values are all means. The definition of the surface position and depth of these nerve entry points and center of the intramuscular nerve-dense regions can improve the localization efficiency and efficacy of target blocking for pectoralis major and minor spasticity.
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Affiliation(s)
- Yanrong Li
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Meng Wang
- Department of Anatomy, Zunyi Medical University, Zunyi, China
| | - Shaohua Tang
- Department of Orthopaedics, Shijie Hospital, Dongguan, China
| | - Xiankun Zhu
- Department of Rehabilitation, Zunyi Medical University, Zunyi, China
| | - Shengbo Yang
- Department of Anatomy, Zunyi Medical University, Zunyi, China
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Chang KV, Chiu YH, Wu WT, Hsu PC, Özçakar L. Botulinum toxin injections for shoulder and upper limb pain: a narrative review. Pain Manag 2020; 10:411-420. [PMID: 33073703 DOI: 10.2217/pmt-2020-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Botulinum toxin (BoNT) has been widely employed to treat poststroke spasticity, cervical dystonia and muscle hyperactivity. Recently, BoNT injections are increasingly used in treating musculoskeletal pain. The mechanism of BoNT in pain relief comprises relaxation of overused muscles and inhibition of inflammatory nociceptive cytokines/neurotransmitters. As BoNT injections seem promising in treating painful musculoskeletal disorders, we aimed to investigate its effectiveness in shoulder and upper limb pain. Although the present article is a narrative review, we employed a systematic approach to search for relevant articles in PubMed. A total of 19 clinical studies were included. Here, we observed that intramuscular BoNT injections were helpful in stroke patients with hemiplegic shoulder pain. In shoulder joint pain, intra-articular and intrabursal BoNT injections achieved a longer period of pain relief than corticosteroid injections. Similarly, a more durable effect of intramuscular BoNT than saline injections was seen in shoulder myofascial pain. Its use in complex regional pain syndrome and persistent upper limb pain in breast cancer survivors was insufficient, necessitating more studies. Since not all of the included studies could provide Class I of evidence based on the efficacy criteria used by American Academy of Neurology, controlled clinical trials in a larger number of patients are necessary to verify validity of these findings in the future.
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Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital & National Taiwan University College of Medicine, Taipei, 10845, Taiwan.,Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, 10048, Taiwan
| | - Yi-Hsiang Chiu
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital & National Taiwan University College of Medicine, Taipei, 10845, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital & National Taiwan University College of Medicine, Taipei, 10845, Taiwan.,Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, 10048, Taiwan
| | - Po-Cheng Hsu
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, 10048, Taiwan
| | - Levent Özçakar
- Department of Physical & Rehabilitation Medicine, Hacettepe University Medical School, Ankara, 06100, Turkey
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Chung TM, Jacinto LJ, Colosimo C, Bhatia KP, Tiley J, Bhidayasiri R. Botulinum Neurotoxin-A Injection in Adult Cervical Dystonia and Spastic Paresis: Results From the INPUT (INjection Practice, Usage and Training) Survey. Front Neurol 2020; 11:570671. [PMID: 33041997 PMCID: PMC7525121 DOI: 10.3389/fneur.2020.570671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/13/2020] [Indexed: 01/13/2023] Open
Abstract
Botulinum toxin-A (BoNT-A) is an effective treatment for cervical dystonia (CD) and spastic paresis (SP), but it requires in-depth knowledge of anatomy and injection techniques. The Ixcellence Network® is an educational programme to provide neurology, neuropaediatrics, and physical medicine and rehabilitation (PMR) specialists with access to best clinical practices and innovations regarding SP and CD management with BoNT-A. To assess the benefits of such educational programmes and identify unmet needs, a multidisciplinary scientific committee designed INPUT (INjection Practice, Usage & Training), an international multicentric survey describing training and practices among this trained and experienced population. A self-completed questionnaire was sent online to 553 trainees and 14 trainers from the Ixcellence Network®. Among the 131 respondents, 92% specialized in PMR (48%) or neurology (44%), with a mean experience of 15.5 years in their clinical fields and 10.9 years of BoNT-A injection. Most of them (98%) reported having received training before performing their first BoNT-A injection and attending specific courses on how to perform it without any instrumental guidance (76%), and with ultrasound (73%), electrical stimulation (44%) or electromyography (41%). In terms of practices, 92% of respondents reported using at least one guidance technique while injecting, with ultrasound being the most used technique (48%). Attending specific courses was significantly associated with greater self-confidence and use, e.g. for injection with ultrasound, mean self-confidence, on a scale from 1 (not confident) to 10 (fully confident), was 7.9 for trained respondents (vs 4.0 for untrained respondents, p < 0.001) of whom 70% stated that they used this technique regularly or systematically (vs. 11% of untrained healthcare professionals (HCPs), p < 0.0001). Moreover, 84% of respondents reported having trained colleagues, residents or fellows through theoretical (70%) or practical teaching in individuals (80%) or in small groups (65%). Overall, 86% of respondents reported a notable increase over the past 5 years of the number of patients treated with BoNT-A. INPUT is the first international survey describing training and practices in SP and CD management of physicians who attended a dedicated educational programme. The results highlighted the importance of training for self-confidence, and the use of specific techniques and new approaches.
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Affiliation(s)
- Tae Mo Chung
- Faculty of Medicine, Institute of Physical Medicine and Rehabilitation, University of São Paulo, São Paulo, Brazil
| | - Luis Jorge Jacinto
- Serviço de Reabilitação de adultos, Centro de Medicina de Reabilitacao do Alcoitão, Alcabideche, Portugal
| | - Carlo Colosimo
- Department of Neurology, Azienda Ospedaliera S.Maria, Terni, Italy
| | - Kailash P Bhatia
- Institute of Neurology, University College London, London, United Kingdom
| | - Julie Tiley
- Global Medical Affairs, Ipsen, Boulogne Billancourt, France
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Kumar P, Turton A, Cramp M, Smith M, McCabe C. Management of hemiplegic shoulder pain: A UK‐wide online survey of physiotherapy and occupational therapy practice. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 26:e1874. [PMID: 33241633 DOI: 10.1002/pri.1874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/13/2020] [Accepted: 07/24/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Praveen Kumar
- Department of Allied Health Professions Faculty of Health and Applied Sciences University of West of England Bristol UK
| | - Ailie Turton
- Department of Allied Health Professions Faculty of Health and Applied Sciences University of West of England Bristol UK
| | - Mary Cramp
- Department of Allied Health Professions Faculty of Health and Applied Sciences University of West of England Bristol UK
| | - Mark Smith
- Leith Community Treatment Centre Edinburgh Scotland UK
| | - Candy McCabe
- Department of Allied Health Professions Faculty of Health and Applied Sciences University of West of England Bristol UK
- Dorothy House Hospice Care Winsley UK
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Risk Factors for Poststroke Shoulder Pain: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2020; 29:104787. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.104787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/12/2020] [Accepted: 02/24/2020] [Indexed: 11/23/2022] Open
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Association of Long-Term Treatment by Botulinum Neurotoxins and Occupational Therapy with Subjective Physical Status in Patients with Post-Stroke Hemiplegia. Toxins (Basel) 2019; 11:toxins11080453. [PMID: 31382438 PMCID: PMC6723584 DOI: 10.3390/toxins11080453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 12/02/2022] Open
Abstract
The short-term effects of botulinum toxin type A (BoNT-A) treatment in stroke patients with upper extremity are well established. This study examined the association between the recovery of motor function of the upper extremity with subjective physical symptoms in outpatients receiving long-term BoNT-A and occupational therapy following stroke. We also investigated the expectations of patients who elected to continue treatment. Forty-seven patients (23 men and 24 women) aged 61 years received BoNT-A treatment more than 20 times. The subjective physical status was analyzed by using the visual analogue scale score through an eight-item questionnaire. Recovery of motor function in the upper extremity was detected by calculating the change (delta) in Fugl–Mayer Assessment (FMA), and ordinal logistic modeling analysis was used to determine the association between the delta-FMA score and the subjective level of agreement for each item. When the ordinal logistic modeling fit was statistically significant, results were interpreted as having logistic probability. The logistic curves discriminating one point (strongly disagree) from five points (strongly agree) were fit in a stepwise fashion. This study suggests that patients receiving long-term BoNT-A treatment and occupational therapy experienced an increased upper extremity mitigation and decreased insomnia after injection, regardless of the recovery of motor function.
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