4.4 Article

Prognosis prediction of the effect of botulinum toxin therapy and intensive rehabilitation on the upper arm function in post-stroke patients using hierarchical cluster analysis

Journal

DISABILITY AND REHABILITATION
Volume 44, Issue 22, Pages 6815-6823

Publisher

TAYLOR & FRANCIS LTD
DOI: 10.1080/09638288.2021.1977394

Keywords

Stroke; spasticity; Botulinum toxin therapy; upper limb; hierarchical cluster analysis

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This study classified patients into different groups based on their functional categories and found that BoNT-A therapy combined with intensive rehabilitation had a significant improvement on upper limb spasticity and function in post-stroke patients. The therapeutic effect was particularly notable in patients with moderate impairment but voluntary movement in shoulder, elbow, forearm, and finger.
Purpose We analysed the effect of botulinum neurotoxin A therapy (BoNT-A) with intensive rehabilitation on the upper limb (UL) spasticity in post-stroke patients by classifying function by UL movement and examining differences in functional improvement. Materials and methods In this non-randomized, controlled study. The patient function was classified into groups from the score of the sub-categories of the Fugl-Meyer Assessment (FMA-UE) before treatment in the Intervention group by hierarchical cluster analysis. Results A total of 139 patients in the Intervention group were classified into six groups. All groups showed a significant improvement in FMA-UE after the intervention. In the group scoring 19-31 points on the FMA-UE and with the voluntary movement of shoulder, elbow, forearm, and finger, a significant improvement was observed compared to the Control group. Further, in the group scoring 26-47 points on the FMA-UE and with the voluntary movement of shoulder, elbow, forearm, wrist, and finger, a significant improvement was observed compared to the Control group. Conclusions In this study, BoNT-A and intensive rehabilitation showed improvement in spasticity and UL function. A high therapeutic effect is expected in patients with moderate impairment levels who have voluntary movement in whole UL or in UL except for the wrist.

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