Table K.7.6Evidence profile for botulinum toxin type A and physical therapy compared with physical therapy alone; upper limb; treatment acceptability assessment

Quality assessmentSummary of findings
No. of patientsEffectQuality
No. of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsBotulinum toxin A (BoNT-A)/Occupational therapyOccupational therapy only all outcomesRelative (95% CI)Absolute
Canadian occupational performance measure - performance (COPM-P) score (change from baseline) Three months (Better indicated by higher values)
3 studies (Boyd 2004; Lowe 2006; Wallen 2007)randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none5663-MD 0.81 higher (0.17 to 1.46 higher)Moderate
Canadian occupational performance measure – satisfaction (COPM-S) score (change from baseline) Four months (Better indicated by higher values)
1 study (Greaves 2004)randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious2none1010-MD 0.76 higher (0.92 lower to 2.44 higher)Moderate
COPM-S score (change from baseline) Six months (Better indicated by higher values)
2 studies (Lowe 2006; Wallen 2007)randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious2none4138-MD 0.35 higher (0.39 lower to 1.08 higher)Moderate
COPM-S score (change from baseline) Cycle 1 (Better indicated by higher values)
1 study (Olesch 2010)randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none1111-MD 1.2 higher (0.15 to 2.25 higher)*Moderate
COPM-S score (change from baseline) Cycle 2 (Better indicated by higher values)
1 study (Olesch 2010)randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none1111-MD 1.2 higher (0.15 to 2.25 higher)*Moderate
COPM-S score (change from baseline) Cycle 3 (Better indicated by higher values)
1 study (Olesch 2010)randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none1111-MD 1.4 higher (0.35 to 2.45 higher)*Moderate
COPM-S score (change from baseline) over whole year (Better indicated by higher values)
1 study (Olesch 2010)randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none1111-MD 0.8 higher (0.11 to 1.49 higher)*Moderate

CI confidence interval, MD mean difference

*

Calculated by the NCC-WCH

Data from Hoare 2010 Cochrane systematic review

1

Total population less than 400, 95% confidence interval for mean difference does not cross null hypothesis but is wide

2

Total population less than 400, 95% confidence interval for mean difference crosses null hypothesis and is wide

From: Appendix K, GRADE tables

Cover of Spasticity in Children and Young People with Non-Progressive Brain Disorders
Spasticity in Children and Young People with Non-Progressive Brain Disorders: Management of Spasticity and Co-Existing Motor Disorders and Their Early Musculoskeletal Complications.
NICE Clinical Guidelines, No. 145.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2012 Jul.
Copyright © 2012, National Collaborating Centre for Women's and Children's Health.

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