Gill Renée, Banky Megan, Yang Zonghan, Medina Mena Pablo, Woo Chi Ching Angie, Bryant Adam, Olver John, Moore Elizabeth, Williams Gavin
Department of Physiotherapy, Epworth Rehabilitation, Epworth Healthcare, Richmond, Melbourne 3121, Australia.
School of Physiotherapy, The University of Melbourne, Parkville, Melbourne 3010, Australia.
Toxins (Basel). 2025 Jul 23;17(8):362. doi: 10.3390/toxins17080362.
Botulinum neurotoxin-A (BoNT-A) injections are effective in reducing focal limb spasticity; however, their impact on strength and active function needs to be established. This review was a secondary analysis aimed at evaluating changes to active function in the context of muscle strength changes following BoNT-A intramuscular injection for adult upper and lower limb spasticity. The original review searched eight databases (CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Google Scholar, MEDLINE, PEDro, PubMed, Web of Science) and was conducted with methodology that followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines as described in section 6.2 of Gill et al. For this secondary analysis, no databases were searched; only further data were extracted. The current and preceding review were registered in the Prospective Register of Systematic Reviews (PROSPERO: CRD42022315241). Twenty studies were screened for inclusion, and three studies were excluded because active function was not assessed in all participants. Seventeen studies (677 participants) met the inclusion criteria for analysis. Quality was examined using the PEDro scale and modified Downs and Black checklist and rated as fair to good. Pre- and post-BoNT-A injection strength (agonist, antagonist, and global), active function (activity), participation, and quality-of-life outcomes at short-, mid-, and long-term time points were extracted and analysed. Significant heterogeneity and limited responsiveness in strength and active function outcome measures limited the ability to determine whether changes in strength mediate an effect on active function. Further, variability in BoNT-A type and dose, adjunctive therapies provided, and variability in reporting limited analyses. Overall, no clear relationship existed between the change in muscle strength and active function following BoNT-A injections to the upper and lower limbs for focal spasticity in adult-onset neurological conditions.
注射肉毒杆菌神经毒素A（BoNT-A）可有效减轻局灶性肢体痉挛；然而，其对力量和主动功能的影响尚待确定。本综述是一项二次分析，旨在评估成人上下肢痉挛患者在接受BoNT-A肌肉注射后，在肌肉力量变化的背景下主动功能的变化。原综述检索了八个数据库（CINAHL、Cochrane对照试验中央注册库（CENTRAL）、Embase、谷歌学术、MEDLINE、PEDro、PubMed、科学网），并按照Gill等人第6.2节所述的系统评价和Meta分析的首选报告项目（PRISMA）指南进行。对于这项二次分析，未检索数据库；仅提取了更多数据。当前和之前的综述已在系统评价前瞻性注册库（PROSPERO：CRD42022315241）中注册。筛选了20项研究以纳入分析，3项研究被排除，因为并非所有参与者都评估了主动功能。17项研究（677名参与者）符合纳入分析的标准。使用PEDro量表和改良的唐斯和布莱克检查表检查质量，评定为中等至良好。提取并分析了BoNT-A注射前后短期、中期和长期的力量（ agonist、antagonist和整体）、主动功能（活动）、参与度和生活质量结果。力量和主动功能结果测量中存在显著的异质性和有限的反应性，限制了确定力量变化是否介导对主动功能影响的能力。此外，BoNT-A类型和剂量、提供的辅助治疗以及报告的变异性限制了分析。总体而言，在成人发病的神经疾病中，注射BoNT-A治疗上下肢局灶性痉挛后，肌肉力量变化与主动功能之间不存在明确的关系。
