Westmead Hospital and The University of Sydney, Australia.
J Rehabil Med. 2011 Nov;43(11):1032-7. doi: 10.2340/16501977-0885.
Limited empirical information exists regarding botulinum toxin-A injector decision-making practices for adult upper limb post-stroke spasticity. The design of most studies prevents such an assessment, as injection sites and dosage are mandated by researcher protocols. This contrasts to usual injector practices, where individualized decision-making is the standard of care.
Secondary data analysis from an Australian randomized controlled trial of 90 adults with upper limb post-stroke spasticity where experienced clinicians followed their standard clinical injecting practice rather than a mandated injection regimen.
Clinicians were hypothesized to tailor their injection practices according to the subject's degree of spasticity and/or the type of functional gain desired. Hypothesis testing was conducted using non-parametric analysis.
Muscle selection and botulinum toxin-A dosage were not significantly associated with spasticity severity or with patient-identified goals. Between-site differences in injection practices suggested that injector beliefs, rather than patient characteristics, were the dominant feature driving botulinum toxin-A injection strategy for post-stroke upper limb spasticity.
This result looks into the "black box" of rehabilitation, revealing significant variation in injector beliefs. Findings suggest that further scientific work is required to maximize the efficacy of botulinum toxin-A injections in post-stroke upper limb spasticity management.
关于成人上肢卒中后痉挛性的肉毒毒素 A 注射者决策实践，目前仅有有限的经验信息。大多数研究的设计都阻止了这种评估，因为注射部位和剂量是由研究人员的方案规定的。这与通常的注射者实践形成对比，在通常的实践中，个体化决策是护理的标准。
对澳大利亚一项 90 例上肢卒中后痉挛性成人的随机对照试验的二次数据分析，其中经验丰富的临床医生遵循其标准临床注射实践，而不是强制性的注射方案。
根据受试者的痉挛程度和/或期望的功能获益类型，假设临床医生会调整他们的注射实践。使用非参数分析进行假设检验。
肌肉选择和肉毒毒素 A 剂量与痉挛严重程度或患者确定的目标均无显著相关性。注射实践的部位间差异表明，注射者的信念而不是患者的特征是驱动卒中后上肢痉挛性肉毒毒素 A 注射策略的主要因素。
该结果深入研究了康复的“黑箱”，揭示了注射者信念的显著差异。研究结果表明，需要进一步开展科学工作，以最大程度地提高肉毒毒素 A 注射在卒中后上肢痉挛性管理中的疗效。
