HammondCare, Level 2, 447 Kent St., Sydney, NSW 2000, Australia.
Syst Rev. 2012 Jun 26;1:29. doi: 10.1186/2046-4053-1-29.
Spasticity of muscles is a common consequence of central nervous system impairment. Traditionally, neurological rehabilitation for spasticity has involved occupational and physical therapy; however, increasingly Botulinum toxin-A injections may be provided. Injection effects are temporary. Consequently, understanding the effect of adjunct physical therapies will help inform multimodal rehabilitation decisions. Presently, these effects are not known. This systematic review will identify and summarize evidence on physical therapies used after Botulinum toxin-A injection to improve motor function in adults with neurological impairments.
Systematic searching of seven electronic databases will occur to identify relevant randomized trials. Available trial data will be extracted into a list of pre-defined primary outcomes, including range of movement, spasticity and functional limb use. Pre-defined secondary outcomes will also be reviewed where trials have these data available for reporting. Effects will be expressed as mean differences or standardized mean differences with 95% confidence intervals (CI). Where possible, comparable results will be meta-analyzed, and a summary of the available pool of evidence produced.All randomized controlled trials will be rated using the PEDro methodological quality scale. Where possible, study data will be meta-analyzed using RevMan 5 Software. The protocol was registered in PROSPERO international prosepective register of systematic reviews (PROSPERO 2011:CRD42011001491).
Review results will be the most comprehensive answer available to the following question: Are physical therapies clinically effective after Botulinum toxin-A injections in adults with neurological spasticity? Results will inform healthcare providers and managers who determine who gets access to and provision of Botulinum toxin-A injection and whether this is done with or without physical therapies. Results will inform the clinicians who conduct physical therapy following injection. This protocol provides readers with the scope and depth of a search that will ultimately answer a complex and pressing treatment question. The variability of current practice and high level of expense associated with multimodal rehabilitation means review results will be more useful and less contestable if the protocol is revealed in full through advance publication.
肌肉痉挛是中枢神经系统损伤的常见后果。传统上，针对痉挛的神经康复涉及职业和物理疗法；然而，越来越多地可能会提供肉毒杆菌毒素-A 注射。注射效果是暂时的。因此，了解辅助物理疗法的效果将有助于为多模式康复决策提供信息。目前，这些效果尚不清楚。本系统评价旨在确定和总结在肉毒杆菌毒素-A 注射后用于改善神经功能障碍成人运动功能的物理疗法的证据。
将对七个电子数据库进行系统搜索，以确定相关的随机试验。将可用的试验数据提取到一个预先确定的主要结果列表中，包括运动范围、痉挛和功能性肢体使用。还将审查有试验提供报告的预先确定的次要结果。效果将表示为均值差异或标准化均值差异，置信区间为 95%（CI）。在可能的情况下，将对可比结果进行荟萃分析，并对现有证据进行汇总。所有随机对照试验都将使用 PEDro 方法学质量量表进行评分。在可能的情况下，将使用 RevMan 5 软件对研究数据进行荟萃分析。该方案已在 PROSPERO 国际系统评价注册库（PROSPERO 2011：CRD42011001491）中进行了注册。
综述结果将是对以下问题的最全面回答：在神经痉挛的成人中，肉毒杆菌毒素-A 注射后物理疗法在临床上是否有效？结果将为确定谁有资格获得肉毒杆菌毒素-A 注射以及是否在有或没有物理疗法的情况下进行注射的医疗保健提供者和管理人员提供信息。结果将为注射后进行物理治疗的临床医生提供信息。本方案为读者提供了搜索的范围和深度，最终将回答一个复杂而紧迫的治疗问题。鉴于当前实践的多样性和与多模式康复相关的高费用水平，如果方案通过预先发表完全公开，那么审查结果将更有用且更不易受到争议。
