Limited Evidence of Functional Benefit After Upper Limb Botulinum Toxin Treatment in Children With Cerebral Palsy: Systematic Review and Meta-analysis.

Objectives: This systematic review and meta-analysis of randomized controlled trials aimed to summarize the reported functional effects of upper limb botulinum toxin treatment in children with spastic cerebral palsy.

Design: Six databases were searched in October 2022. Two independent authors screened and extracted data on upper limb function, body function, life quality, muscle tone, spasticity, goals, pain, adverse events, and client satisfaction. A random effect model meta-analysis was performed, and RoB 2 and GRADE pro tools were used.

Results: A total of 4862 publications were screened, 14 trials (621 patients) included. Pooled analyses confirm a decrease in muscle tone: mean difference Ashworth scale wrist -0.85 (95% confidence interval = -1.42 to -0.27). No significant functional gain was established: Melbourne Assessment mean difference 3.13 (95% confidence interval = -3.13 to 9.3), and Assisting Hand Assessment mean difference 3.84 (95% confidence interval = -1.86 to 9.54). Botulinum toxin groups had better goal achievement: Goal Attainment Scaling T scores mean difference 9.55 (95% confidence interval = 6.05 to 13.04) and better client satisfaction: improvement had an odds ratio of 8.44 (95% confidence interval = 1.34 to 53.08).

Conclusions: Results suggest that upper limb botulinum toxin treatment is effective to decrease muscle tone, but functional benefits are not clearly established. The discrepancy between subjective and objective results requires further investigation.