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    The efficacy of Botulinum Toxin A on improving ease of care in the upper and lower limbs: A systematic review and meta-analysis using the Grades of Recommendation, Assessment, Development and Evaluation approach

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    Authors
    Baker, J.
    Pereira, Gavin
    Date
    2015
    Type
    Journal Article
    
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    Citation
    Baker, J. and Pereira, G. 2015. The efficacy of Botulinum Toxin A on improving ease of care in the upper and lower limbs: A systematic review and meta-analysis using the Grades of Recommendation, Assessment, Development and Evaluation approach. Clinical Rehabilitation. 29 (8): pp. 731-740.
    Source Title
    Clinical Rehabilitation
    DOI
    10.1177/0269215514555036
    ISSN
    0269-2155
    Funding and Sponsorship
    http://purl.org/au-research/grants/nhmrc/1052236
    URI
    http://hdl.handle.net/20.500.11937/37080
    Collection
    • Curtin Research Publications
    Abstract

    OBJECTIVES: A systematic review and meta-analysis using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach; evaluating Botulinum Toxin type A efficacy on improving ease of care in the upper/lower limb. DATA SOURCES: Pubmed, Cinahl, Amed, Embase and Cochrane databases. English Language. Search to July 2014. REVIEW METHODS: All randomized, placebo controlled trials on adults with difficulty in caring for the upper/lower limb resulting from spasticity of any origin and treated with a single dose of Botulinum Toxin A. Evidence quality was assessed by GRADE. RESULTS: A total of 32 studies were reviewed. Meta-analysis was carried out on 11 upper limb and three lower limb studies. Evidence quality for the upper limb was moderate. A significant result for Botulinum Toxin A was found at four to 12 weeks for the upper limb (SMD 0.80, CI 0.55, 1.06, p < 0.0001). The effects were maintained for up to six months (SMD 0.48, CI 0.34, 0.62, p < 0.0001). Evidence quality was very low for the lower limb. Meta-analysis was only possible for global assessment of benefit. No significant effect was found. (PATIENT: RR 1.37 CI (0.94, 2.00) p = 0.11; clinician: RR 1.06 (0.84, 1.34) p = 0.60.) CONCLUSION: Botulinum Toxin A improves ease of care in the upper limb for up to six months. No conclusion can be drawn for the lower limb.

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