Effectiveness of Botulinum Toxin A in Treatment of Hemiplegic Shoulder Pain: A Systematic Review and Meta-analysis |
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| Institution: | 1. Veterans Affairs Medical Center, Washington, DC;2. Georgetown University, Washington, DC;3. MedStar Washington Hospital Center, Washington, DC;4. Baylor University Medical Center, Dallas, TX;5. Aristotle University, Thessaloniki, Greece;6. University of Alabama at Birmingham;7. Ain Shams University, Cairo, Egypt;8. George Washington University, Washington, DC;9. University of California, Los Angeles;1. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 5 Fu-Hsing Street, Kweishan, Taoyuan, Taiwan;2. Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5 Fu-Hsing Street, Kweishan, Taoyuan, Taiwan;3. College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kweishan, Taoyuan, Taiwan;4. Graduate Institute of Clinical Medicine, Chang Gung University, Tao-Yuan, Taiwan;5. Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan;6. Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Tao-Yuan, Taiwan;7. Department of Cardiovascular Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan;8. Resource Center for Clinical Research, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan |
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| Abstract: | ObjectiveTo evaluate the effectiveness of botulinum toxin A (BTX-A) in the treatment of hemiplegic shoulder pain.Data SourcesPubMed, EMBASE, Elsevier, Springer, Cochrane Library, Physiotherapy Evidence Database, CNKI, and VIP were researched from the earliest records to September 1, 2020.Study SelectionRandomized controlled trials that compared shoulder BTX-A injections vs a control intervention in patients with a history of hemiplegic shoulder pain after stroke were selected. Among the 620 records screened, 9 trials with 301 eligible patients were included.Data ExtractionOutcome data were pooled according to follow-up intervals (1, 2, 4, and 12 wk). The primary evaluation indices were pain reduction (visual analog scale VAS] score) and range of motion (ROM) improvement. The second evaluation indices were upper limb functional improvement, spasticity improvement, and incidence of adverse events. Cochrane risk-of-bias was used to assess the methodological quality of studies independently by 2 evaluators.Data SynthesisMeta-analysis revealed a statistically significant decrease in the VAS score in the BTX group vs the control group at 1, 4, and 12 weeks postinjection (wk 1: standardized mean difference SMD], 0.91; 95% confidence interval CI], 0.27 to 1.54; wk 4: SMD, 1.63; 95% CI, 0.76 to 2.51; wk 12: SMD, 1.96; 95% CI, 1.44 to 2.47). Furthermore, the meta-analysis demonstrated a statistically significant increase in abduction at 1, 4, and 12 weeks postinjection (wk 1: SMD, 3.71; 95% CI, 0 to 7.41; wk 4: SMD, 8.8; 95% CI, 2.22 to 15.37; wk 12: SMD, 19.59; 95% CI, 9.05 to 30.13) and external rotation at 1, 2, 4 weeks postinjection (wk 1: SMD, 5.67; 95% CI, 0.88 to 10.47; wk 2: SMD, 9.62; 95% CI, 5.57 to 13; wk 4: SMD, 6.89; 95% CI, 2.45 to 11.33) in the BTX group.ConclusionsBTX-A injection provided greater analgesic effects and increased shoulder abduction and external rotation ROM compared with steroid or placebo injection for the treatment of HSP. |
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| Keywords: | Botulinum toxins Pain Rehabilitation Review Stroke BTX-A"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"botulinum Toxin A CI"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"confidence interval HSP"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"hemiplegic shoulder pain MAS"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"modified Ashworth score RCT"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"randomized controlled trial ROM"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"range of motion SMD"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"standardized mean difference VAS"} {"#name":"keyword" "$":{"id":"kwrd0105"} "$$":[{"#name":"text" "_":"visual analog scale |
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