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Optimising the methods of evaluation of the effectiveness of botulinum toxin treatment of post-stroke muscle spasticity

Correspondence to:
Correspondence to:
Professor A M O Bakheit
Neurological Rehabilitation, Peninsula Medical School and Plymouth Primary Care Trust, Mount Gould Hospital, Plymouth PL4 7QD, UK; magid.bakheit{at}pcs-tr.swest.nhs.uk

Keywords: botulinum toxin; muscle spasticity; stroke

The first 150 words of the full text of this article appear below.

The effectiveness of botulinum toxin type A (BtxA) in reducing post-stroke muscle hypertonia and its complications has been demonstrated in adult patients in at least eight large randomised controlled trials (RCTs).^1–8 The clinical benefits were reported when diverse treatment protocols and different dose schedules and injection techniques were used for the management of the same clinical indication. Nonetheless, some doubt as to the value of this treatment remain.⁹ What is the explanation for this apparent paradox? The contradiction may be explained by the inadequate design of these studies and the inherent difficulties with the interpretation of the results of RCTs of a drug treatment that is carried out in the context of rehabilitation for a person with chronic neurological disability. The WHO classification of functioning, disability, and health¹⁰ provides a useful framework for understanding the complex relation between the statistical significance and the clinical significance of a . . . [Full text of this article]