Neurology India · 2022
A Comparison of Treatment Options in Focal Post-Stroke Spasticity of the Upper Extremity: A Prospective Longitudinal Cohort Study from Kerala, India.
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Sankaran Ravi, Raj Manu
Аннотация
BACKGROUND: Post-stroke 20%-40% of patients develop spasticity which can quadruple total cost of care. This impact can be reduced by affordable treatment options for focal spasticity.
OBJECTIVES: The primary objective of the study was to compare changes in Passive Range of Movements in patients with focal post-stroke spasticity from pre-treatment to end of 1 month of treatment with anti-spastic agents. The secondary objectives were to measure the changes in Modified Ashworth, and Brunnstrom Recovery Staging during the same period.
MATERIALS AND METHODS: This prospective longitudinal cohort study was conducted in a tertiary level rehabilitation center. One hundred and three adults with post-stroke spasticity participated. The patients received one of the four options: Phenol, Onabotulinum toxin, Bupivacaine and Hyaluronidase.The main outcome measures were the following: Changes in Passive Range of Movement (PRoM), Brunnstrom staging (BRS) and Modified Ashworth Scale (MAS).
RESULT: Post intervention testing at 1 month was done. Each agent significantly improved BRS (1.10, 95% CI 0.8-1.4, P = 0.001) and PRoM (32.28, 95% CI 27.66- 36.89, P = 0.001), while reducing MAS (0.39, 95% CI 0.01-0.77, P = 0.05). In addition, subgroup comparisons were done with phenol as a reference for all three outcome measures. There was a significant difference in the improvement of Brunnstrom staging for Bupivacaine (0.52, 0.094-0.95, 0.02) compared to phenol. Similarly, Hyaluronidase showed better improvement in MAS (0.39, 0.01-0.77, 0.05) compared to Phenol.
CONCLUSION: There was a significant difference in PRoM, MAS and Brunnstrom staging from baseline to end of 1 month long anti-spasticity treatment.
OBJECTIVES: The primary objective of the study was to compare changes in Passive Range of Movements in patients with focal post-stroke spasticity from pre-treatment to end of 1 month of treatment with anti-spastic agents. The secondary objectives were to measure the changes in Modified Ashworth, and Brunnstrom Recovery Staging during the same period.
MATERIALS AND METHODS: This prospective longitudinal cohort study was conducted in a tertiary level rehabilitation center. One hundred and three adults with post-stroke spasticity participated. The patients received one of the four options: Phenol, Onabotulinum toxin, Bupivacaine and Hyaluronidase.The main outcome measures were the following: Changes in Passive Range of Movement (PRoM), Brunnstrom staging (BRS) and Modified Ashworth Scale (MAS).
RESULT: Post intervention testing at 1 month was done. Each agent significantly improved BRS (1.10, 95% CI 0.8-1.4, P = 0.001) and PRoM (32.28, 95% CI 27.66- 36.89, P = 0.001), while reducing MAS (0.39, 95% CI 0.01-0.77, P = 0.05). In addition, subgroup comparisons were done with phenol as a reference for all three outcome measures. There was a significant difference in the improvement of Brunnstrom staging for Bupivacaine (0.52, 0.094-0.95, 0.02) compared to phenol. Similarly, Hyaluronidase showed better improvement in MAS (0.39, 0.01-0.77, 0.05) compared to Phenol.
CONCLUSION: There was a significant difference in PRoM, MAS and Brunnstrom staging from baseline to end of 1 month long anti-spasticity treatment.