Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jan 5;7(1):1.
doi: 10.1186/s13643-017-0670-9.

A systematic review: efficacy of botulinum toxin in walking and quality of life in post-stroke lower limb spasticity

Anupam Datta Gupta  1 , Wing Hong Chu  2 , Stuart Howell  3 , Subhojit Chakraborty  4 , Simon Koblar  5 , Renuka Visvanathan  6 , Ian Cameron  7 , David Wilson  8
Affiliations

A systematic review: efficacy of botulinum toxin in walking and quality of life in post-stroke lower limb spasticity

Anupam Datta Gupta et al. Syst Rev. .

Abstract

Background: Improved walking is one of the highest priorities in people living with stroke. Post-stroke lower limb spasticity (PSLLS) impedes walking and quality of life (QOL). The understanding of the evidence of improved walking and QOL following botulinum toxin (BoNTA) injection is not clear. We performed a systematic review of the randomized control trials (RCT) to evaluate the effectiveness of BoNTA injection on walking and QOL in PSLLS.

Methods: We searched PubMed, Web of Science, Embase, CINAHL, ProQuest Thesis and Dissertation checks, Google Scholar, WHO International Clinical Trial Registry Platform, ClinicalTrials.gov , Cochrane, and ANZ and EU Clinical Trials Register for RCTs looking at improvement in walking and QOL following injection of BoNTA in PSLLS. The original search was carried out prior to 16 September 2015. We conducted an additional verifying search on CINHAL, EMBASE, and MEDLINE (via PubMed) from 16 September 2015 to 6 June 2017 using the same clauses as the previous search. Methodological quality of the individual studies was critically appraised using Joanna Briggs Institute's instrument. Only placebo-controlled RCTs looking at improvement in walking and QOL were included in the review.

Results: Of 2026 records, we found 107 full-text records. Amongst them, we found five RCTs qualifying our criteria. No new trials were found from the verifying search. Two independent reviewers assessed methodological validity prior to inclusion in the review using Joanna Briggs Institute's appraisal instrument. Two studies reported significant improvement in gait velocity (p = 0.020) and < 0.05, respectively. One study showed significant improvement in 2-min-walking distance (p < 0.05). QOL was recorded in one study without any significant improvement. Meta-analysis of reviewed studies could not be performed because of different methods of assessing walking ability, small sample size with large confidence interval and issues such as lack of power calculations in some studies. Findings from our systematic and detailed study identify the need for a well-designed RCT to adequately investigate the issues highlighted.

Conclusions: This review could not conclude there was sufficient evidence to support or refute improvement on walking or QOL following BoNTA injection. Reasons for this are discussed, and methods for future RCTs are developed.

Keywords: Botulinum toxin; Lower limb; Spasticity; Stroke.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Bonita R, Mendis S, Truelsen T, Bogousslavsky, Toole James, Yatsu Frank. The global stroke initiative. Lancet Neurol. 2004;3(7):391–393. - PubMed
    1. Wissel J, Manack A, Brainin M. Toward an epidemiology of post stroke spasticity. Neurology. 2013;80(3):S13–S19. doi: 10.1212/WNL.0b013e3182762448. - DOI - PubMed
    1. Zorowitz RD, Gillard PJ, Brainin M. Post stroke spasticity. Neurology. 2013;80(Suppl 2):S45–S52. doi: 10.1212/WNL.0b013e3182764c86. - DOI - PubMed
    1. Stinear C. Prediction of recovery of motor function after stroke. Lancet Neurol. 2010;9(12):1228–1232. doi: 10.1016/S1474-4422(10)70247-7. - DOI - PubMed
    1. Shaw L, Rodgers H. Botulinum toxin type A for upper limb spasticity after stroke. Expert Rev Neurother. 2009;9(12):1715–1725. doi: 10.1586/ern.09.121. - DOI - PubMed

Publication types