The effectiveness of therapy on outcome following (BoNT-A) injection for focal spasticity in adults with neurological conditions: A systematic review.

Objective: To determine the independent effectiveness of adjunctive therapies when provided in conjunction with botulinum neurotoxin (BoNT-A) injection for focal spasticity in adults with neurological conditions.

Data Sources: Nine electronic databases.

Study Selection: A systematic search was performed to identify randomized, controlled trials (RCTs) evaluating the benefit of adjunctive therapies following BoNT-A injection.

Data Extraction/synthesis: Two authors extracted the data independently. Each trial was assessed for internal validity and rated for quality using the PEDro scale. Articles were further appraised using the American Academy of Neurology (AAN) evidence classification to construct concise clinical recommendations.

Results: The search identified 12 studies that reported on the effects of eight different adjunctive therapies following BoNT-A injection in adults with focal spasticity. No high level evidence was identified. The mean PEDro score for the 12 studies was 5.6 (SD = 1.6) and the clinical recommendations provided were Grade U, indicating the effectiveness of the adjunctive therapies was unknown or unproven.

Conclusion: There was insufficient evidence to support or refute the effectiveness of any of the commonly prescribed adjunctive therapies following BoNT-A injection for focal spasticity in adults.