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

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单位: [1]Huazhong Univ Sci & Technol, Tongji Hosp, Dept Rehabil Med & Phys Therapy, Wuhan, Peoples R China [2]Jilin Univ, First Hosp Jilin Univ, Dept Rehabil Med & Phys Therapy, Changchun, Peoples R China [3]Albaath Univ, Dept Phys Therapy, Homs, Syria [4]Damascus Univ, Assad Univ Hosp, Dept Orthoped Surg, Damascus, Syria [5]Tanta Univ, Tanta Univ Hosp, Phys Med Rheumatol & Rehabil, Fac Med, Tanta, Egypt [6]Assiut Univ Hosp, Dept Rheumatol, Assiut, Egypt [7]Mohammed VI Univ Hosp Oujda, Immunohematol Cellular Therapy, Med Sch Oujda, Oujda, Morocco [8]Natl Taiwan Univ, Phys Med & Rehabil, Hosp Bei Hu Branch, Taipei, Taiwan [9]Natl Taiwan Univ Hosp, Dept Phys Med & Rehabil, Bei Hu Branch, Taipei, Taiwan [10]Whipps Cross Hosp Barts Hlth Natl Hlth Serv NHS, Pain Management, London, England [11]Univ Hosp Azienda Osped Univ AOU Careggi, Med Geriat Dept Rheumatol, Florence, Italy [12]Jordan Univ Sci & Technol, King Abdullah Univ Hosp, Amman, Jordan [13]Cleveland Clin, Anesthesia & Pain Med, Abu Dhabi, U Arab Emirates [14]Res Paolo Procacci Fdn, Rome, Italy
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关键词: botulinum toxin cimt mcimt neuroplasticity rehabilitation spasticity stroke

摘要:
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 (ADCs).

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大类 | 4 区 医学
小类 | 4 区 医学:内科
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Q3 MEDICINE, GENERAL & INTERNAL

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第一作者单位: [1]Huazhong Univ Sci & Technol, Tongji Hosp, Dept Rehabil Med & Phys Therapy, Wuhan, Peoples R China
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