ABSTRACT
INTRODUCTION: Spasticity is common after a stroke and is an independent risk factor for developing pain. BotulinumtoxinA injection is the treatment of choice for focal spasticity. We examined the effect of intramuscular botulinumtoxinA on pain relief in patients in routine clinical practice who were experiencing pain as a primary complaint associated with post-stroke lower limb spasticity. METHODS: Prospective, multicentre, post-marketing observational study. The study period was 16 months. The primary effectiveness variable was the mean change from baseline on the pain 0-10 Numerical Rating Scale after four botulinumtoxinA injection cycles. Secondary endpoints included changes from baseline on the pain 0-100 Visual Analogue Scale, Goal Attainment Scale, modified Ashworth Scale, 10-Meter Walk Test, Penn Spasm Frequency Scale, and 36-item Short-Form Health Survey. RESULTS: Of 186 enrolled patients, 180 (96.8%) received botulinumtoxinA at least once. The mean (standard deviation) pain 0-10 Numerical Rating Scale score decreased significantly (p<0.0001) from 4.9 (2.2) at baseline to 2.5 (2.1) at study end, representing a 50% decrease in pain severity. Relief of pain due to spasticity was supported by improvement from baseline in all secondary variables except the 10-Meter Walk Test. Two adverse events (erysipelas and phlebitis) in one patient were considered likely to be related to botulinumtoxinA injection. CONCLUSION: BotulinumtoxinA appears to provide pain relief as an additional benefit of local treatment in patients with post-stroke lower limb spasticity for whom pain relief is a primary therapeutic goal (a Lay Abstract has been provided as Appendix A).
Subject(s)
Botulinum Toxins, Type A , Lower Extremity , Muscle Spasticity , Neuromuscular Agents , Pain Measurement , Stroke , Humans , Muscle Spasticity/drug therapy , Muscle Spasticity/etiology , Prospective Studies , Female , Male , Botulinum Toxins, Type A/administration & dosage , Stroke/complications , Middle Aged , Aged , Neuromuscular Agents/administration & dosage , Injections, Intramuscular , Pain/etiology , Pain/drug therapy , Pain Management/methods , Product Surveillance, Postmarketing , Treatment OutcomeSubject(s)
Betacoronavirus , Coronavirus Infections/rehabilitation , Pandemics , Pneumonia, Viral/rehabilitation , Telerehabilitation , COVID-19 , Confidentiality , Delivery of Health Care , Exercise Therapy , Humans , Interdisciplinary Communication , Medicine , Patient Care Team , Precision Medicine , SARS-CoV-2 , Social Change , Spain , Telerehabilitation/legislation & jurisprudence , Telerehabilitation/methods , Telerehabilitation/organization & administrationABSTRACT
Spasticity is a common complication that occurs in those patients that have suffered a stroke. To identify those patients at high risk of having post-stroke spasticity and to start treatment at early stages would probably benefit the patient. The key aspects in the early management of post-stroke spasticity were review and the clinical implications and strength of evidences were also considered. The document drafted by the study coordinators was subsequently reviewed and then a validated document was developed. The experts recommend defining early treatment of spasticity as one that begins before the first three months after stroke. The panel considers very important to identify the risk factors associated with the onset of spasticity, since this might reduce its impact. Additionally, the most common conditions subsidiaries of early treatment of both upper and lower limb are defined. The panel recommends that the treatment with botulinum toxin A must only be given by specialists with experience in diagnosis and management of spasticity. In conclusion, the treatment of focal spasticity in the first three months after stroke is indicated in certain situations. These recommendations help to standardize the early management of post-stroke spasticity, with the consequent support to clinicians and patients.
TITLE: Tratamiento farmacologico temprano de la espasticidad postictus con toxina botulinica tipo A: recomendaciones de consenso basadas en la evidencia.La espasticidad es una secuela comun en los pacientes que han sufrido un ictus. La identificacion de pacientes con alto riesgo de presentar espasticidad postictus e iniciar el tratamiento en fases tempranas probablemente beneficiaria al paciente. Se revisaron las areas clave en el manejo temprano de la espasticidad postictus, y se consideraron las implicaciones clinicas y la solidez de las evidencias. El documento elaborado por los coordinadores fue sometido a revision y se elaboro un texto, que finalmente se valido. El grupo de expertos recomienda definir el tratamiento temprano de la espasticidad como el que comienza antes de los tres primeros meses tras el ictus. El panel considera muy importante identificar los factores de riesgo asociados con la aparicion de la espasticidad, ya que esto podria reducir su impacto. Se definen las situaciones mas frecuentes subsidiarias de tratamiento precoz tanto del miembro superior como del miembro inferior. El panel recomienda que el tratamiento con toxina botulinica tipo A sea administrado por especialistas que posean una amplia experiencia en el diagnostico y manejo clinico de la espasticidad. En conclusion, el tratamiento de la espasticidad focal en los primeros tres meses tras un ictus esta indicado en determinadas situaciones. Estas recomendaciones ayudan a estandarizar el manejo temprano de la espasticidad postictus, con la consiguiente ayuda para el clinico y los pacientes.
Subject(s)
Botulinum Toxins, Type A/therapeutic use , Evidence-Based Medicine , Muscle Spasticity/drug therapy , Neuromuscular Agents/therapeutic use , Stroke/physiopathology , Consensus , HumansABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Occupational Therapy/methods , Occupational Therapy/trends , /trends , Primary Health Care/methods , Primary Health Care , Rehabilitation/methods , Rehabilitation/trends , Occupational Therapy , Physical Therapy Specialty , Physical Therapy Specialty/organization & administration , Physical Therapy Specialty/standards , RehabilitationABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Research/classification , Research/methods , Research/standards , Use of Scientific Information for Health Decision Making , Scientific Research and Technological Development , Scientific Publication Indicators , Research/organization & administration , Publications for Science DiffusionABSTRACT
No disponible
Subject(s)
Humans , Scientific Publication Ethics , Scientific Misconduct/ethics , Scientific Misconduct/trends , Duplicate Publications as Topic , Rehabilitation/education , Scientific Misconduct/statistics & numerical data , Rehabilitation/organization & administration , Rehabilitation/standardsSubject(s)
Humans , Male , Female , Video-Audio Media/statistics & numerical data , Video-Audio Media/standards , Video-Audio Media , Video Recording/methods , Gait/physiology , Gait Disorders, Neurologic/rehabilitation , Hemiplegia/rehabilitation , Gait Apraxia/rehabilitation , Hemiplegia/complications , Hemiplegia/diagnosis , Hemiplegia/therapySubject(s)
Humans , Male , Female , Research/instrumentation , Research/standards , Biomedical Research/methods , Scientific Research and Technological Development , Research Report , Rehabilitation/education , Rehabilitation/methods , Rehabilitation/organization & administration , Rehabilitation/statistics & numerical data , Rehabilitation/trendsABSTRACT
No disponible
Subject(s)
Humans , Whiplash Injuries/classification , Cervical Vertebrae/injuries , Syndrome , Clinical Trials as Topic , Cervical Vertebrae/pathology , Cervical Vertebrae/pathology , Whiplash Injuries/etiology , Whiplash Injuries/rehabilitation , RadiographyABSTRACT
Objetivo: Demostrar la efectividad de las ondas de choque extracorpóreas en las tendinitis calcificadas de hombro. Pacientes y método: Presentamos un estudio prospectivo, aleatorizado y doble ciego con grupo control, de los efectos de las ondas de choque extracorpóreas en 50 pacientes con tendinitis calcificada de hombro. Los pacientes fueron aleatorizados en 5 grupos, recibieron diferentes dosis y niveles de energía. El grupo control recibió tratamiento simulado. Resultados: Los resultados iniciales a las 8 semanas del tratamiento demuestran una mejoría significativa en el 82 por ciento de los pacientes. La escala de Constant mejoró de 64,16 ñ 13 a 84,07 ñ 15.Mejoraron en el dolor, actividades de la vida diaria, recorrido articular y fuerza. La efectividad de realizar una o 2 sesiones no fue significativa. En un 60 por ciento de los pacientes, se observó una reabsorción completa o parcial del depósito de calcio. El grupo control no demostró cambios significativos. Conclusión: En pacientes con tendinitis calcificada de hombro sintomática, el tratamiento mediante ondas de choque extracorpóreas ayuda a resolver la calcificación y está asociado a una mejoría clínica (AU)
Subject(s)
Humans , Lithotripsy/methods , Shoulder Pain/etiology , Calcinosis/complications , Tendinopathy/therapy , Rotator Cuff/physiopathology , Pain Measurement , Informed ConsentABSTRACT
This study is an analysis of the Memotherm prosthesis in spinal cord injured patients with Detrusor-external sphincter dyssynergia (DESD). Twenty-four patients were evaluated urodynamically before and after placement of the intraurethral stent prosthesis. All the patients had been chronically managed with an indwelling urinary catheter, intermittent catheterization or condom catheters. Sixty-six per cent had history of recurrent urinary tract infection, 37% had symptoms of autonomic dysreflexia. Nine patients had previous external sphincterotomy. Follow-up ranged from 3 39 months (mean 15.4 months). After stent insertion all patients were able to achieve spontaneous reflex voiding with the use of condom catheter. Postoperative urodynamics parameters bladder leak point pressure and residual urine volume decreased significantly after stent insertion. Stent insertion was accomplished without any operative complications. In four patients stent migration (16%) required telescoping a new system over the migrated stent. In two patients the stent was removed because of problems of infection and calculus formation. In conclusion, this system (Memotherm) is an attractive, and potentially reversible treatment for DESD in SCI patients.
