The Effect of Botulinum Toxin Type A Injection in the Rectus Femoris in Stroke Patients Walking With a Stiff Knee Gait: A Randomized Controlled Trial.

IF 3.7 2区医学 Q1 CLINICAL NEUROLOGY Neurorehabilitation and Neural Repair Pub Date : 2023-09-01 Epub Date: 2023-08-29 DOI:10.1177/15459683231189712

Martin J B Tenniglo, Anand V Nene, Johan S Rietman, Jaap H Buurke, Erik C Prinsen

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Abstract

Background: Over activity of the rectus femoris is often cited as a main cause for stiff knee gait (SKG). Botulinum toxin (BoNT) can be used to reduce this over activity. Inconsistent results for the effect of BoNT injections were found in literature which can possibly be explained by the study design as these were uncontrolled or non-randomized studies.

Objective: To conduct a randomized controlled trial (RCT) to investigate the effect of botulinum toxin type A (BoNT-A) injections in the rectus femoris on gait kinematics and functional outcome in adult stroke patients.

Methods: Twenty-six participants were included in this triple-blind cross-over RCT. The intervention consisted of an injection with BoNT-A. Placebo is an injection with saline. Besides knee and hip kinematics, functional outcomes were measured.

Results: Comparison of the effect of BoNT-A injection to placebo injection showed a significant increase in peak knee flexion and knee range of motion of 6.7° and 4.8° respectively. There was no difference in hip kinematics. In functional outcomes, only the 6 Minute Walking Test showed a significant increase of 18.3 m.

Conclusions: BoNT-A injections in the rectus femoris is a valuable treatment option for stroke patients walking with a SKG to improve knee kinematics. To study the effect on functional outcome more research is necessary with different functional outcome measures that can capture the effect in kinematics. It is important to use kinematic measurements to demonstrate effects in quality of movement that are not captured by commonly used functional outcome measurements post stroke.Clinical Trial Registration: https://trialsearch.who.int/Trial2.aspx?TrialID=NTR2169.

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股直肌注射A型肉毒毒素对膝关节步态僵硬的中风患者的影响：一项随机对照试验。

背景：股直肌过度活动经常被认为是膝关节步态僵硬的主要原因。肉毒杆菌毒素（BoNT）可以用来减少这种过度活性。在文献中发现了BoNT注射效果的不一致结果，这可能可以通过研究设计来解释，因为这些是非对照或非随机研究。目的：进行随机对照试验（RCT），研究股直肌注射a型肉毒杆菌毒素（BoNT-a）对成年脑卒中患者步态运动学和功能结果的影响。方法：26名参与者被纳入这项三盲交叉随机对照试验。干预包括注射BoNT-A。安慰剂是用生理盐水注射的。除了膝关节和髋关节运动学，还测量了功能结果。结果：BoNT-A注射液与安慰剂注射液的疗效比较显示，峰值膝关节屈曲和膝关节活动范围分别显著增加6.7°和4.8°。髋关节运动学没有差异。在功能结果方面，只有6分钟步行测试显示显著增加了18.3米。结论：股直肌注射BoNT-a是中风患者使用SKG步行改善膝关节运动学的有价值的治疗选择。为了研究对功能结果的影响，有必要对不同的功能结果测量进行更多的研究，以捕捉运动学中的影响。使用运动学测量来证明运动质量的影响是很重要的，而中风后常用的功能结果测量没有捕捉到这些影响。临床试验注册：https://trialsearch.who.int/Trial2.aspx?TrialID=NTR2169.

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来源期刊

Neurorehabilitation and Neural Repair 医学-康复医学

CiteScore

8.30

自引率

4.80%

发文量

审稿时长

6-12 weeks

期刊介绍： Neurorehabilitation & Neural Repair (NNR) offers innovative and reliable reports relevant to functional recovery from neural injury and long term neurologic care. The journal''s unique focus is evidence-based basic and clinical practice and research. NNR deals with the management and fundamental mechanisms of functional recovery from conditions such as stroke, multiple sclerosis, Alzheimer''s disease, brain and spinal cord injuries, and peripheral nerve injuries.