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Reebye R, Jacinto LJ, Balbert A, Biering-Soerensen B, Carda S, Draulans N, Molteni F, O'Dell MW, Picelli A, Santamato A, Verduzco-Gutierrez M, Walker H, Wissel J, Francisco GE. Multimodal therapy and use of adjunctive therapies to BoNT-A in spasticity management: defining terminology to help enhance spasticity treatment. Front Neurol 2024; 15:1432330. [PMID: 39281409 PMCID: PMC11392737 DOI: 10.3389/fneur.2024.1432330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/15/2024] [Indexed: 09/18/2024] Open
Abstract
Spasticity management should be provided within the context of a comprehensive person-centered rehabilitation program. Furthermore, active goal setting for specific spasticity interventions is also important, with a well-established "more is better" approach. It is critical to consider adjunctive therapy and multimodal approaches if patients are not attaining their treatment goals. Often used interchangeably, there may be confusion between the terms adjunctive and multimodal therapy. Yet it is imperative to understand the differences between these approaches to achieve treatment goals in spasticity management. Addition of a secondary pharmacologic or non-pharmacologic treatment to optimize the efficacy of the initial modality, such as adding electrical stimulation or casting to BoNT-A, is considered an adjunctive therapy. Adjunctive therapy is time-specific and requires the added therapy be initiated within a specific period to enhance the primary treatment; usually within 2 weeks. Multimodal therapy is an integrated, patient-centric program of pharmacologic and non-pharmacologic strategies utilized in a concurrent/integrated or sequential manner to enhance the overall treatment effect across a variety of spasticity-associated impairments (e.g., neural and non-neural components). Moreover, within a multimodal approach, adjunctive therapy can be used to help enhance the treatment effect of one specific modality. The objectives of this paper are to clarify the differences between adjunctive and multimodal therapies, provide a brief evidence-based review of such approaches, and highlight clinical insights on selecting multimodal and adjunctive therapies in spasticity management.
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Affiliation(s)
- Rajiv Reebye
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Luis Jorge Jacinto
- Adult Rehabilitation Service, Alcoitão Rehabilitation Medicine Center, Estoril, Portugal
| | - Alexander Balbert
- Department of Adaptive Physical Training, Ural University of Physical Education, Sverdlovsk Regional Hospital for War Veterans, Yekaterinburg, Russia
| | - Bo Biering-Soerensen
- Neurological Department, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Stefano Carda
- Neuropsychology and Neurorehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - Nathalie Draulans
- Department of Rehabilitation, Libra Rehabilitation and Audiology, Eindhoven, Netherlands
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Italy
| | - Michael W O'Dell
- Clinical Rehabilitation Medicine, Weill Cornell Medicine and Neuro Rehabilitation Consultants, New York, NY, United States
| | - Alessandro Picelli
- Neuromotor and Cognitive Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Santamato
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, Foggia, Italy
| | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Heather Walker
- Physical Medicine and Rehabilitation, Ralph H. Johnson VA Medical Center, Charleston, SC, United States
| | - Joerg Wissel
- Neurology and Psychosomatic at Wittenbergplatz, Berlin and University Potsdam, Potsdam, Germany
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center McGovern Medical School, Houston, TX, United States
- Physical Medicine and Rehabilitation, The Institute for Rehabilitation and Research (TIRR) Memorial Hermann Hospital, Houston, TX, United States
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Hull M, Danchenko N, Anupindi VR, DeKoven M, He J, Bouchard J. Health care resource utilization and costs among patients with spasticity or cervical dystonia. J Manag Care Spec Pharm 2024; 30:86-97. [PMID: 38055046 PMCID: PMC10775770 DOI: 10.18553/jmcp.2023.22205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Spasticity and cervical dystonia (CD) are movement disorders with considerable direct and indirect health care cost implications. Although several studies have discussed their clinical impact, few have calculated the economic burden of these disorders. OBJECTIVE To assess the all-cause health care resource utilization (HCRU) and costs in adults and children with spasticity or CD. METHODS This retrospective, observational cohort-based study was conducted using administrative insurance claims from the IQVIA PharMetrics Plus database from October 1, 2015, to December 31, 2019. Patients were selected based on International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for first evidence of spasticity (associated with a spasticity etiology) or CD (index date) during the selection window, from April 1, 2016, through December 31, 2018. Cases were stratified into 3 mutually exclusive cohorts: adult patients with spasticity, pediatric patients with spasticity, and patients with CD; those with spasticity who had a history of stroke or cerebral palsy were also evaluated in subcohorts. Patients without evidence of spasticity or CD during the study period were identified as a matched comparator group and were randomly assigned an index date. Patients with spasticity were matched 1:1 to the comparator group based on age, sex, index year, and payer type using descriptive analyses. RESULTS 215,739 adult patients with spasticity, 29,644 pediatric patients with spasticity, and 9,035 adult patients with CD were identified after matching. Adult patients with spasticity and CD had mean (SD) ages of 48.4 (15.6) years and 48.0 (13.1) years, respectively. Stroke was identified in 31.9% (n = 68,928) of adult patients with spasticity, and cerebral palsy was identified in 11.3% (n = 3,364) of pediatric patients with spasticity. Adult and pediatric patients with spasticity and patients with CD had significantly higher HCRU (including mean number of outpatient, emergency department, and inpatient visits and proportions of patients with prescription fills) and higher mean total health care costs per patient (adult patients with spasticity $29,912 vs $7,464; pediatric patients with spasticity $16,089 vs $2,963; and patients with CD $20,168 vs $7,141) than matched comparators (all P<0.0001). CONCLUSIONS The management of patients with spasticity or CD results in considerably higher health care expenses. Within managed health care systems, more effective management of spasticity and CD in adult and pediatric patients represents a significant opportunity for cost savings.
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Esquenazi A, Bloudek L, Migliaccio-Walle K, Oliveri D, Tung A, Gillard P, Verduzco-Gutierrez M. Healthcare resource utilization and costs among patients with post-stroke spasticity before and after spasticity management including onabotulinumtoxina. J Rehabil Med 2023; 55:jrm11626. [PMID: 37902443 DOI: 10.2340/jrm.v55.11626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Real-world data regarding the impact of onabotulinumtoxinA on healthcare resource utilization and costs for post-stroke spasticity are scarce. OBJECTIVE To compare differences in 12-month healthcare resource utilization and costs before and after post-stroke spasticity management including onabotulinumtoxinA. METHODS This retrospective claims analysis of IBM MarketScan Commercial and Medicare Supplemental databases included adults with ≥ 1 onabotulinumtoxinA claim for post-stroke spasticity (1 January 2010 to 30 June 2018) and continuous enrolment for ≥ 12 months pre- and post-index (first onabotulinumtoxinA claim date). All-cause and spasticity-related healthcare resource utilization and costs were compared 12 months pre- and post-index (McNemar's χ2 test or paired t-test). A subgroup analysis assessed effect of stroke-to-index interval on costs. RESULTS Among 735 patients, mean (standard deviation) stroke-date-to-index-date interval was 284.5 (198.8) days. Decreases were observed post-index for mean all-cause outpatient (62.9 vs 60.5; p ≤ 0.05) and emergency department visits (1.1 vs 0.8; p ≤ 0.0001), and hospital admissions (1.5 vs 0.4; p ≤ 0.0001). Increase in prescription fills (43.0 vs 53.7) was seen post-index. Post-index decreases in all-cause (-66%) and spasticity-related (-51%) costs were driven by reduced inpatient care costs. Findings were consistent regardless of stroke-date-to-index-date interval. CONCLUSION Significant reductions in healthcare resource utilization and costs were observed after 1 year of post-stroke spasticity management including onabotulinumtoxinA. Long-term studies are needed to establish causality.
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Affiliation(s)
- Alberto Esquenazi
- MossRehab Gait and Motion Analysis Laboratory, Elkins Park, PA, USA.
| | | | | | | | - Amy Tung
- Allergan, an AbbVie Company, Chicago, IL, USA
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Morone G, Baricich A, Paolucci S, Bentivoglio AR, De Blasiis P, Carlucci M, Violi F, Levato G, Pani M, Carpagnano LF, Spandonaro F, Picelli A, Smania N. Long-Term Spasticity Management in Post-Stroke Patients: Issues and Possible Actions-A Systematic Review with an Italian Expert Opinion. Healthcare (Basel) 2023; 11:healthcare11060783. [PMID: 36981442 PMCID: PMC10048278 DOI: 10.3390/healthcare11060783] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
Spasticity is a well-known motor dysfunction occurring after a stroke. A group of Italian physicians' experts in treating post-stroke spasticity (PSS) reviewed the current scientific evidence concerning the state-of-the-art clinical management of PSS management and the appropriate use of botulinum toxin, aiming to identify issues, possible actions, and effective management of the patient affected by spasticity. The participants were clinicians specifically selected to cover the range of multidisciplinary clinical and research expertise needed to diagnose and manage PSS. When evidence was not available, the panel discussed and agreed on the best way to manage and treat PSS. To address the barriers identified, the panel provides a series of consensus recommendations. This systematic review provides a focused guide in the evaluation and management of patients with PSS and its complications. The recommendations reached by this panel of experts should be used by less-experienced doctors in real life and should be used as a guide on how to best use botulinum toxin injection in treating spasticity after a stroke.
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Affiliation(s)
- Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
- San Raffaele Institute of Sulmona, 67039 Sulmona, Italy
| | - Alessio Baricich
- Physical Medicine and Rehabilitation, Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| | | | - Anna Rita Bentivoglio
- Neuroscience Department, Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Roma, Italy
| | - Paolo De Blasiis
- Department of Mental and Physical Health and Preventive Medicine, Section of Human Anatomy, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | | | - Francesco Violi
- Internal Medicine Department, Sapienza Università di, 00185 Roma, Italy
| | | | - Marcello Pani
- Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Roma, Italy
| | | | - Federico Spandonaro
- C.R.E.A. Sanità, University San Raffaele, 00166 Rome, Italy
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), 00196 Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
- Canadian Advances in Neuro-Orthopaedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z6, Canada
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
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Lindsay C, Humphreys I, Phillips C, Pandyan A. Estimating the cost consequence of the early use of botulinum toxin in post-stroke spasticity: Secondary analysis of a randomised controlled trial. Clin Rehabil 2023; 37:373-380. [PMID: 36325678 PMCID: PMC9912301 DOI: 10.1177/02692155221133522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To estimate the cost-consequence of treating spasticity early with botulinum toxin in the acute stroke unit. DESIGN Secondary cost-consequence analysis, using data from a double-blind randomised-controlled trial. SETTING Single-centre specialised stroke unit. SUBJECTS AND INTERVENTIONS Patients with Action Research Arm Test grasp-score of <2 and who developed spasticity within six weeks of a first stroke were randomised to receive injections of: 0.9% sodium-chloride solution (placebo) or onabotulinumtoxin-A (treatment). MAIN MEASURES Resource use costs were calculated for the study. Mean contracture costs for each group were calculated. The Barthel Index and Action Research Arm Test were used to generate a cost per unit of improvement. RESULTS There were no significant differences associated with early treatment use. The mean contracture cost for the treatment group was £817 and for the control group was £2298 (mean difference = -£1481.1(95% CI -£2893.5, -£68.7) (p = 0.04). The cost per unit of improvement for the Barthel Index was -£1240 indicating that the intervention costs less and is more effective. The cost per unit of improvement for the Action Research Arm Test was -£450 indicating that the intervention costs less and is more effective. CONCLUSIONS Treating spasticity early in stroke patients at risk of contractures with botulinum toxin leads to a significant reduction in contracture costs. The cost per improvement of Barthel and Action Research Arm Test indicates that the intervention costs less and is more effective. TRIAL REGISTRATION DATA EudraCT(2010-021257-39) and ClinicalTrials.gov-Identifier:NCT01882556.
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Affiliation(s)
- Cameron Lindsay
- 46 Bangor Road, Holywood, Down, UK
- Cameron Lindsay, 46 Bangor Road, Holywood,
Down, BT18 0LQ, UK.
| | - Ioan Humphreys
- Swansea University, First Floor, Vivian Building, Singleton Campus,
Swansea, UK
| | - Ceri Phillips
- Swansea University, First Floor, Vivian Building, Singleton Campus,
Swansea, UK
| | - Anand Pandyan
- Bournemouth University, Bournemouth Gateway Building (Rm 507), St
Pauls Lane, Bournemouth, UK
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Ji Y, Wang Y, Lou H, Zhang Y, Liu Y, Zheng X, Jia X, Yang K, Zhang H, Cong D. Tuina combined with physical therapy for spasticity of poststroke: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e28780. [PMID: 35147106 PMCID: PMC8830876 DOI: 10.1097/md.0000000000028780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Limb spasms are a common complication of stroke. It not only affects the quality of life of stroke survivors, but also brings an economic burden. Tuina combined with physical therapy is widely used in the rehabilitation of poststroke spasticity. However, there is no supporting evidence for its efficacy and safety. This study aimed to evaluate the effectiveness and safety of Tuinas combined with physical therapy in the treatment of spasticity after stroke. METHODS Literature will be collected from the following databases: China Biology Medicine (CBM), Wanfang Database, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), PubMed, Embase, Cochrane Library, and Web of Science; We will include randomized controlled trials of Tuina combined with physical therapy for poststroke spasticity range from the establishment to May 1, 2021. There were no limitations to the publication time, and the language was limited to Chinese and English. The primary outcome was evaluated using the Modified Ashworth scale, and the secondary outcomes were the simplified Fugl-Meyer Assessment scale, Modified Barthel Index, Functional Independence Measurement (FIM), and Visual Analog Scale. RevMan V.5.4.1 software was used for the meta-analysis. The Cochrane Intervention System Evaluation Manual analyzes the risk of bias, and the recommended grading assessment, development and evaluation are used to assess the quality of evidence. ETHICS AND DISSEMINATION This study will be based on published systematic review studies, no ethical approval is required and the results of the study will be published in a peer-reviewed scientific journal. SYSTEMATIC REVIEW REGISTRATION INPLASY2021110064.
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Affiliation(s)
- Yuanyuan Ji
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Yufeng Wang
- Department of Tuina, Traditional Chinese Medicine Hospital of Jilin Province, China
| | - Huijuan Lou
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Yuxin Zhang
- Department of Biochemistry and Molecular Biology, Traditional Chinese Medicine Hospital of Jilin Province, China
| | - Yangshengjie Liu
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Xu Zheng
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Xiushuang Jia
- Department of Ophthalmology and Otolaryngology of Chinese Medicine, Traditional Chinese Medicine Hospital of Jilin Province, Changchun, China
| | - Kang Yang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Hongshi Zhang
- Department of Nursing, Changchun University of Chinese Medicine, Changchun, China
| | - Deyu Cong
- Department of Tuina, Traditional Chinese Medicine Hospital of Jilin Province, China
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Lou H, Li Z, Pang T, Zhang X, Meng M, Yang K, Zhang H, Wang Y, Cong D. Electrocupuncture combined rehabilitation therapy for upper limb spasticity after stroke: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27963. [PMID: 34964786 PMCID: PMC8615300 DOI: 10.1097/md.0000000000027963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the effectiveness and safety of electroacupuncture combined with rehabilitation in the treatment of spasticity after stroke. METHODS To collect relevant literature, we will research following databases: Medicine, PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wan-Fang Database, Chongqing VIP Chinese Science and Technology Periodicals Database and China Biomedical Database; the time is from its creation to May 2021, and the language is limited to Chinese and English. In addition, we will retrieve other literature resources, including the Chinese Clinical Trial Register and conference papers. Two reviewers will independently complete the literature screen and data extraction, and quality assessment of the included studies will be independently completed by two other researchers. The primary outcomes included the Modified Ashworth scale (MAS) and the simplified Fugl-Meyer Assessment scale (SFMA). The Modified Barthel Index (MBI), the China Stroke Scale (CSS), and adverse reactions as secondary outcomes were assessed. RevMan V.5.4.1 software will be used for meta-analysis, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) will be used to assess the quality of evidence. RESULTS This systematic review will provide a high-quality synthesis to evaluate the efficacy and safety of electroacupuncture combined with rehabilitation therapy in the treatment of upper limb spasticity after stroke, providing a reference for the safe and effective treatment of upper limb spasm after stroke. CONCLUSION This study provides evidence that electroacupuncture combined with rehabilitation therapy is effective. ETHICS AND DISSEMINATION The protocol of the systematic review does not require ethical approval because it does not involve humans. This article will be published in peer-reviewed journals and presented at relevant conferences. SYSTEMATIC REVIEW REGISTRATION INPLASY202160005.
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Affiliation(s)
- Huijuan Lou
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Zhanxin Li
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Tingting Pang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Xinxin Zhang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Meng Meng
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Kang Yang
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Hongshi Zhang
- Department of Nursing, Changchun University of Chinese Medicine, Changchun, China
| | - Yufeng Wang
- Department of Tuina, Traditional Chinese Medicine Hospital of Jilin Province, Changchun, China
| | - Deyu Cong
- Department of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
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Xie L, Xie Y, Mao G, Cao S, Fang R, Zhou S, Jiang J, Yao T, Fan J, Liu D, Wu D, Ge J. Decreased spasticity of Baishaoluoshi Decoction through the BDNF/TrKB-KCC2 pathway on poststroke spasticity rats. Neuroreport 2021; 32:1183-1191. [PMID: 34284448 PMCID: PMC8389354 DOI: 10.1097/wnr.0000000000001709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/11/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE K+-Cl- cotransporter-2 (KCC2), which primarily extrudes chloride in mature neurons, triggers hemiplegia limb spasticity after ischemic stroke by affecting neuronal excitability. Our previous study revealed that the Chinese herb Baishaoluoshi Decoction decreases hemiplegia limb spasticity in poststroke spasticity (PSS) patients. This study aimed at elucidating on the effects of Baishaoluoshi Decoction on the BDNF/TrKB-KCC2 pathway in PSS rat models. METHODS Middle cerebral artery occlusion (MCAO) was adopted for the establishment of PSS rat models. Muscle tension was evaluated by Modified Ashworth Scale. Nissl staining and transmission electron microscopy were used to measure the protective effects of Baishaoluoshi Decoction on ischemic injury-induced neuronal damage due to MCAO. Expression levels of BDNF, TrKB, and KCC2 in brain tissues around the infarct and brainstem were detected by immunohistochemical staining. RESULTS It was found that Baishaoluoshi Decoction suppressed hemiplegia limb spasticity and alleviated the damage in neurons and synapses in PSS rat models. Importantly, the expression of BDNF, TrKB, and KCC2 in brain tissues around the infarct and brainstem were significantly upregulated after treatment with low-dose and high-dose Baishaoluoshi Decoction. CONCLUSION Suppression of spasticity by Baishaoluoshi Decoction in PSS rat models may be correlated with upregulated BDNF/TrKB-KCC2 pathway, which may be a complementary therapeutic strategy for PSS.
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Affiliation(s)
- Le Xie
- Neurology Department, Hunan Academy of Chinese Medicine Affiliated Hospital
| | - Yao Xie
- Neurology Department, Hunan Academy of Chinese Medicine Affiliated Hospital
| | - Guo Mao
- Neurology Department, Hunan Academy of Chinese Medicine Affiliated Hospital
| | - Sijia Cao
- Foreign Languages Department, School of Humanities and Management, Hunan University of Chinese Medicine
| | - Rui Fang
- Chinese Pharmacy Teaching and Research Department, College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan
| | - Shen Zhou
- Neurology Department, Hunan Academy of Chinese Medicine Affiliated Hospital
| | - Junlin Jiang
- Neurology Department, Hunan Academy of Chinese Medicine Affiliated Hospital
| | - Ting Yao
- Neurology Department, Hunan Academy of Chinese Medicine Affiliated Hospital
| | - Jianhu Fan
- Neurology Department, Hunan Academy of Chinese Medicine Affiliated Hospital
| | - Dong Liu
- Hunan Key Laboratory of Prevention and Treatment in Cardiovascular Disease, College of Pharmacy, Guiyang University of Chinese Medicine, Guiyang, Guizhou, China
| | - Dahua Wu
- Neurology Department, Hunan Academy of Chinese Medicine Affiliated Hospital
| | - Jinwen Ge
- Chinese Pharmacy Teaching and Research Department, College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan
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Zhang Q, Ji G, Cao F, Sun Y, Hu G, Sun S, Liu Y, Cao J, Wang Y, Xu X, Song B. Tuina for spasticity of poststroke: protocol of a systematic review and meta-analysis. BMJ Open 2020; 10:e038705. [PMID: 33303441 PMCID: PMC7733218 DOI: 10.1136/bmjopen-2020-038705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Spasticity is a common complication of poststroke, tuina is a widely used rehabilitation treatment, although there is a lack of supportive evidence on efficacy and safety for patients with poststroke spasticity. The aim of this systematic review is to assess and synthesis evidence of efficacy and safety of tuina for spasticity of poststroke. METHODS AND ANALYSIS A comprehensive electronic search of EMBASE, MEDLINE, Cochrane Library, Web of Science, Wiley, Springer, PEDro, Chinese Science Citation Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific and Journal Database (VIP), Wanfang Database (Wanfang), Japanese medical database (CiNii), Korean Robotics Institute Summer Scholars and Thailand Thai-Journal Citation Index Centre will be conducted to search literatures of randomised controlled trials of tuina for spasticity of poststroke survivors range from the establishment to 1 January 2020.There is no time of publication limitations. The primary outcome will be measured with the Modified Ashworth Scale, and the second outcome will include Fugl-Meyer Assessment Scale, surface electromyogram RMS value, the Modified Barthel Index, Stroke Specific Quality of Life Scale, quality of life 36-Item Short-Form Health Survey and Visual Analogue Scale. Cochrane Handbook for Systematic Reviews of Interventions will be used to assess the risk of bias, and GRADE will be used to access the confidence in cumulative evidence. The protocol will be conducted according to approach and Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015. ETHICS AND DISSEMINATION Ethical approval will not be required, for no primary data of individual patients were collected. We will publish the findings in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020163384.
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Affiliation(s)
- Qiongshuai Zhang
- Acupuncture and Tuina Department, Changchun University of Chinese Medicine, Changchun, China
| | - Guangcheng Ji
- Rehabilitation Medicine Department, Changchun University of Chinese Medicine, Changchun, China
| | - Fang Cao
- Acupuncture Department, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Yihan Sun
- TCM Department, Changchun University of Chinese Medicine, Changchun, China
| | - Guanyu Hu
- Acupuncture and Tuina Department, Changchun University of Chinese Medicine, Changchun, China
| | - Shaoqian Sun
- Rehabilitation Medicine Department, Jilin University Third Affiliated Hospital, Changchun, China
| | - Yanze Liu
- Acupuncture and Tuina Department, Changchun University of Chinese Medicine, Changchun, China
| | - Jiazhen Cao
- Acupuncture and Tuina Department, Changchun University of Chinese Medicine, Changchun, China
| | - Yufeng Wang
- Tuina Department, First Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Xiaohong Xu
- Graduate School, Changchun University of Chinese Medicine, Changchun, China
| | - Bailin Song
- Acupuncture and Tuina Department, Changchun University of Chinese Medicine, Changchun, China
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Milte R, Ratcliffe J, Ada L, English C, Crotty M, Lannin NA. Protocol for the economic evaluation of the InTENSE program for rehabilitation of chronic upper limb spasticity. BMC Health Serv Res 2020; 20:478. [PMID: 32460773 PMCID: PMC7254740 DOI: 10.1186/s12913-020-05333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/18/2020] [Indexed: 12/03/2022] Open
Abstract
Background Assessment of the costs of care associated with chronic upper-limb spasticity following stroke in Australia and the potential benefits of adding intensive upper limb rehabilitation to botulinum toxin-A are key objectives of the InTENSE randomised controlled trial. Methods Recruitment for the trial has been completed. A total of 139 participants from 6 stroke units across 3 Australian states are participating in the trial. A cost utility analysis will be undertaken to compare resource use and costs over 12 months with health-related quality of life outcomes associated with the intervention relative to a usual care comparator. A cost effectiveness analysis with the main clinical measure of outcome, Goal Attainment Scaling, will also be undertaken. The primary outcome measure for the cost utility analysis will be the incremental cost effectiveness ratio (ICER) generated from the incremental cost of the intervention as compared to the incremental benefit, as measured in quality adjusted life years (QALYs) gained. The utility scores generated from the EQ-5D three level instrument (EQ-5D-3 L) measured at baseline, 3 months and 12 months will be utilised to calculate the incremental Quality Adjusted Life Year (QALY) gains for the intervention relative to usual care using area-under the curve methods. Discussion The results of the economic evaluation will provide evidence of the total costs of care for patients with chronic upper limb spasticity following stroke. It will also provide evidence for the cost-effectiveness of adding evidence-based movement therapy to botulinum toxin-A as a treatment, providing important information for health system decision makers tasked with the planning and provision of services.
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Affiliation(s)
- Rachel Milte
- Caring Futures Institute, Flinders University, Adelaide, South Australia, 5001, Australia.
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, Adelaide, South Australia, 5001, Australia
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Rehabilitation Services, Flinders Medical Centre, Adelaide, Australia
| | - Natasha A Lannin
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia.,Alfred Health, Melbourne, Australia.,John Walsh Centre for Rehabilitation Research, The University of Sydney, Sydney, Australia
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