Ashford Stephen, Turner-Stokes Lynne
Regional Rehabilitation Unit, Northwick Park Hospital, London, UK.
Physiother Res Int. 2013 Sep;18(3):178-89. doi: 10.1002/pri.1554. Epub 2013 Apr 30.
This paper aimed to select studies evaluating botulinum toxin (BoNT) intervention applied for upper-limb spasticity and from these identify outcome measures that are a) applicable in the hemiparetic upper limb and b) include evaluation of functional outcome in the context of everyday real-life activities.
A systematic search was used to identify peer-reviewed papers evaluating BoNT intervention for focal spasticity management in the upper limb. From these papers, outcome evaluation methods were identified, which attempted to capture 'active function' improvement (functional use of the hand and/or arm) or passive function improvement (care for the affected limb, for example to maintain hygiene and dress or support the arm).
The search yielded 411 studies. Seventy papers were identified following a final review of the abstracts as potentially including evaluation of functional outcome (active and/or passive function). Following the review of the papers, a total of 22 studies contained specific methods for evaluating functional outcome in the upper limb.
Three different patient-focused methods to evaluate functional outcome following focal spasticity intervention using BoNT have been identified: 1) use of patient report of upper-limb items (including the Leeds Adult Spasticity Impact Scale and the Disability Assessment Scale), 2) use of a composite measure of function incorporating functional items and 3) Goal Attainment Scaling. None of these methods fully address evaluation of functional outcome in this context but may go some way to recording these improvements. An alternative or complementary measure, recently published, is the Arm Activity Measure for evaluation of active and passive function in this context. The Arm Activity Measure addresses active and passive function changes from the perspective of patients and carers and has been developed for application in this context.
本文旨在筛选评估肉毒杆菌毒素（BoNT）用于上肢痉挛干预的研究，并从中确定符合以下条件的结局指标：a）适用于偏瘫上肢；b）包括在日常实际活动背景下对功能结局的评估。
采用系统检索的方法，识别评估BoNT干预上肢局灶性痉挛管理的同行评审论文。从这些论文中，确定结局评估方法，这些方法试图捕捉“主动功能”改善（手和/或手臂的功能使用）或被动功能改善（对患肢的护理，例如保持卫生、穿衣或支撑手臂）。
检索得到411项研究。在对摘要进行最终评审后，确定了70篇论文可能包括功能结局（主动和/或被动功能）评估。在对这些论文进行评审后，共有22项研究包含评估上肢功能结局的具体方法。
已确定三种不同的以患者为中心的方法来评估使用BoNT进行局灶性痉挛干预后的功能结局：1）使用患者对上肢项目的报告（包括利兹成人痉挛影响量表和残疾评估量表）；2）使用包含功能项目的功能综合测量方法；3）目标达成量表。在这种情况下，这些方法均未完全解决功能结局评估问题，但可能在一定程度上记录这些改善情况。最近发表的一种替代或补充测量方法是手臂活动测量法，用于评估这种情况下的主动和被动功能。手臂活动测量法从患者和护理人员的角度解决了主动和被动功能变化问题，并且是为此背景下的应用而开发的。
