TY - JOUR
T1 - Management of stroke patients submitted to botulinum toxin type a therapy
T2 - A Delphi survey of an Italian expert panel of specialist injectors
AU - Italian Spasticity Study Group
AU - Franceschini, M.
AU - Iocco, M.
AU - Molteni, F.
AU - Santamato, A.
AU - Smania, N.
AU - Antonacci, R.
AU - Balestrieri, F.
AU - Baricich, A.
AU - Bertoni, M.
AU - Castagna, A.
AU - Cavazza, S.
AU - Chisari, C.
AU - Coleschi, P.
AU - Cosma, M.
AU - Crisci, C.
AU - Currá, A.
AU - D'Aurizio, C.
AU - D'Avenia, L.
AU - Dell'Accio, D.
AU - Di Lorenzo, L.
AU - Dimanico, U.
AU - Forcellini, Marco Elio
AU - Fresu, M.
AU - Galardi, G.
AU - Gennaro, L.
AU - Giovanelli, M.
AU - Lazzarini, C.
AU - Leo, L.
AU - Lucangeli, A.
AU - Maggioni, G.
AU - Manca, M.
AU - Milletti, D.
AU - Misceo, S.
AU - Morgante, F.
AU - Mori, L.
AU - Picelli, A.
AU - Pinto, F.
AU - Pisano, F.
AU - Posteraro, F.
AU - Quatrale, R.
AU - Romano, M.
AU - Salghetti, A.
AU - Sandrini, G.
AU - Sanguinetti, G.
AU - Santoro, A.
AU - Schierano, S.
AU - Sciarrini, F.
AU - Servodio Iammarrone, C.
AU - Servodio Iammarrone, F.
AU - Terranova, C.
N1 - Publisher Copyright:
© 2014, Edizioni Minerva Medica. All rights reserved.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Background. Spasticity is a common disabling symptom of several neurological conditions including stroke. Botulinum toxin type A (BTX-A) injection represents the goldstandard therapy for focal spasticity. Post-stroke management of patients receiving BTX-A therapy has been variously investigated, but general agreement on how andwhen to implement rehabilitation is lacking. Aim. To perform a national survey of experts on the most appropriate rehabilitation procedures after BTX-A therapyfor the focal treatment of spasticity. Design. The study employed the Delphi technique through the COSMO project (Consensus on Post-InjectionManagement in Post-stroke Spasticity). Methods. Italian neurologists and physiatrists with experience in BTX-A therapy were selected to participatein the survey. Their anonymous opinions on key issues in treatment strategies in post-stroke spasticity were collected in three sequential rounds facilitated by a web platform.Consensus on a given issue was defined as agreed opinion by at least 66% of the survey participants. Results. In all, 44 Italian experts were involved. Positiveconsensus was reached on the need to start rehabilitation during the first week after BTX-A injection therapy, with a rehabilitation program comprising both stretchingcombined with electrical stimulation and exercise therapy. Functional surgery may be considered only after 12-24 months in cases of BTX-A therapy failure. Theuse of commercial or custom-made orthoses in selected cases was recommended. The appropriate time interval between two BTX-A injections is 3-6 months, and clinicalassessment should be performed 1 month after injection. Conclusion. The results of this national survey confirm that clinical experts on the use of BTX-A therapy forspasticity after stroke agree on the need to initiate rehabilitation treatment immediately after BTX-A injection: muscle stretching exercises, eventually combined withneuromuscular electrical stimulation, may enhance the effect of BTX-A therapy. Outcome after BTX-A therapy should be assessed at repeated follow-up visits. Clinical Rehabilitation Impact. This expert panel survey can provide guidance for clinicians in the assessment of patients treated with BTX-A therapy.
AB - Background. Spasticity is a common disabling symptom of several neurological conditions including stroke. Botulinum toxin type A (BTX-A) injection represents the goldstandard therapy for focal spasticity. Post-stroke management of patients receiving BTX-A therapy has been variously investigated, but general agreement on how andwhen to implement rehabilitation is lacking. Aim. To perform a national survey of experts on the most appropriate rehabilitation procedures after BTX-A therapyfor the focal treatment of spasticity. Design. The study employed the Delphi technique through the COSMO project (Consensus on Post-InjectionManagement in Post-stroke Spasticity). Methods. Italian neurologists and physiatrists with experience in BTX-A therapy were selected to participatein the survey. Their anonymous opinions on key issues in treatment strategies in post-stroke spasticity were collected in three sequential rounds facilitated by a web platform.Consensus on a given issue was defined as agreed opinion by at least 66% of the survey participants. Results. In all, 44 Italian experts were involved. Positiveconsensus was reached on the need to start rehabilitation during the first week after BTX-A injection therapy, with a rehabilitation program comprising both stretchingcombined with electrical stimulation and exercise therapy. Functional surgery may be considered only after 12-24 months in cases of BTX-A therapy failure. Theuse of commercial or custom-made orthoses in selected cases was recommended. The appropriate time interval between two BTX-A injections is 3-6 months, and clinicalassessment should be performed 1 month after injection. Conclusion. The results of this national survey confirm that clinical experts on the use of BTX-A therapy forspasticity after stroke agree on the need to initiate rehabilitation treatment immediately after BTX-A injection: muscle stretching exercises, eventually combined withneuromuscular electrical stimulation, may enhance the effect of BTX-A therapy. Outcome after BTX-A therapy should be assessed at repeated follow-up visits. Clinical Rehabilitation Impact. This expert panel survey can provide guidance for clinicians in the assessment of patients treated with BTX-A therapy.
KW - Botulinum toxins
KW - Delphi technique
KW - Muscle spasticity
KW - Rehabilitation
UR - https://www.scopus.com/pages/publications/84922479392
M3 - Article
SN - 1973-9087
VL - 50
SP - 525
EP - 533
JO - European Journal of Physical and Rehabilitation Medicine
JF - European Journal of Physical and Rehabilitation Medicine
IS - 5
ER -