Cordero-García Carlos, de Torres Irene, Formigo-Couceiro Jacobo, Guirao Lluis, Romero-Torres Mª Dolores, Otero-Villaverde Sergio, Herrera Alberto, Santa Cristina, Mena-Rodriguez Antonio
Juan Ramón Jiménez University Hospital, Ronda Exterior Norte s/n, 21005 Huelva, Spain.
Reina Sofía University Hospital, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain.
Toxins (Basel). 2025 Jan 16;17(1):40. doi: 10.3390/toxins17010040.
The study aimed to identify expert opinions and obtain recommendations on the management of post-stroke hemiplegic shoulder pain (HSP) and treatment with botulinum toxin A (BoNT-A). A multicenter Delphi study was conducted using an online survey designed by a committee of experts with at least 10 years of experience in post-stroke HSP management with BoNT-A in Spain. Forty-seven panelists (specialists with at least 5 years of experience in post-stroke HSP management with BoNT-A) rated their level of agreement in two rounds based on acceptance by ≥66.7% of them. In round 1, 245 statements on three dimensions were evaluated (diagnosis, treatment, and follow-up of the HSP patients treated with BoNT-A). A total of 159 statements (70.9%) were finally accepted after round 2. Experts recommended BoNT-A as soon as spasticity affects daily activities. They considered ultrasound as the preferred guided technique. Experts recommended regular assessments using validated scales and patient-reported outcomes to evaluate treatment goals and safety. In case of lack of response, experts suggested increasing the dose or number of treated muscles or considering alternative treatments. These consensus-based recommendations offer clinicians an approach to the management of post-stroke HSP with BoNT-A, supporting informed decision making.
该研究旨在确定专家意见，并获取有关中风后偏瘫肩痛（HSP）管理及肉毒毒素A（BoNT - A）治疗的建议。在西班牙，由一个在使用BoNT - A治疗中风后HSP方面拥有至少10年经验的专家委员会设计了一项在线调查，开展了一项多中心德尔菲研究。47名小组成员（在使用BoNT - A治疗中风后HSP方面拥有至少5年经验的专家）基于至少66.7%的成员接受情况，在两轮中对他们的同意程度进行了评分。在第一轮中，对关于三个维度（使用BoNT - A治疗的HSP患者的诊断、治疗和随访）的245条陈述进行了评估。第二轮后，共有159条陈述（70.9%）最终被接受。专家建议一旦痉挛影响日常活动就尽快使用BoNT - A。他们认为超声是首选的引导技术。专家建议使用经过验证的量表和患者报告的结果进行定期评估，以评估治疗目标和安全性。如果没有反应，专家建议增加剂量或治疗肌肉的数量，或者考虑替代治疗。这些基于共识的建议为临床医生提供了一种使用BoNT - A管理中风后HSP的方法，支持明智的决策。
