Table 7.1Evidence profile for botulinum toxin type A and physical therapy compared with physical therapy alone; upper limb; tone and joint movement assessment

Number of studiesNumber of participantsEffectQuality
Botulinum toxin type A and occupational therapyOccupational therapy onlyRelative

(95% CI)
Absolute

(95% CI)
MAS score, shoulder adductors at 4 months
1 study (Greaves 2004)99OR 0.20 (0.03, 1.15)-Low
MAS score, elbow flexors at 3 months
2 studies (Russo 2007; Wallen 2007)4139OR 0.16 (0.06 to 0.43)-Moderate
MAS score, elbow flexors at 6 months
2 studies (Russo 2007; Wallen 2007)4139OR 0.33 (0.13 to 0.86)-Low
MTS score (mean change from baseline), elbow flexors at 4 months (better indicated by lower values)
1 study (Greaves 2004)99-MD 43.89 lower (92.99 lower to 5.21 higher)Low
MTS score (mean final score), elbow flexors at 4 months, cycle 1 (better indicated by lower values)
1 study (Olesch 2010)11a11b-MD 34.3 lower (70.67 lower to 2.07 higher)*Moderate
MTS score (mean final score), elbow flexors, cycle 2 (better indicated by lower values)
1 study (Olesch 2010)11c11d-MD 36 lower (71.3 to 0.7 lower)*Moderate
MTS score (mean final score), elbow flexors, cycle 3 (better indicated by lower values)
1 study (Olesch 2010)11e11f-MD 42.8 lower (86.48 lower to 0.88 higher)*Moderate
PROM elbow extension (change from baseline) at 3 months (better indicated by higher values)
2 studies (Fehlings 2000; Wallen 2007)3431-MD 0.11 higher (2.96 lower to 3.19 higher)Low
PROM elbow extension (change from baseline) at 6 months (better indicated by higher values)
2 studies (Fehlings 2000; Wallen 2007)3432-MD 0.15 lower (3.38 lower to 3.07 higher)Low
MAS score, pronators at 3 months
1 study (Wallen 2007)2017OR 1.58 (0.45 to 5.52)-Moderate
MAS score, pronators at 4 months
1 study (Greaves 2004)99OR 0.13 (0.02 to 0.97)-Low
MAS score, pronators at 6 months
1 study (Wallen 2007)2017OR 1.5 (0.22 to 10.16)-Low
MTS score (mean change from baseline), forearm pronators at 4 months, cycle 1 (better indicated by lower values)
1 study (Olesch 2010)11g11h-MD 4 higher*Low
MTS score (mean change from baseline), forearm pronators, cycle 2 (better indicated by lower values)
1 study (Olesch 2010)11i11j-MD 5.8 lower*Low
MTS score (mean change from baseline), forearm pronators, cycle 3 (better indicated by lower values)
1 study (Olesch 2010)11k11l-MD 18.5 lower*Low
AROM supination (change from baseline) at 3 months (better indicated by higher values)
1 study (Speth 2005)1010-MD 16.3 lower (33.01 lower to 0.41 higher)Moderate
AROM supination (change from baseline) at 6 months (better indicated by higher values)
1 study (Speth 2005)1010-MD 8.4 lower (36.74 lower to 19.94 higher)Moderate
PROM forearm supination (change from baseline) at 3 months (better indicated by higher values)
2 studies (Fehlings 2000, Wallen 2007)3431-MD 3.64 higher (0.92 lower to 8.2 higher)Low
PROM forearm supination (change from baseline) at 6 months (better indicated by higher values)
2 studies (Fehlings 2000, Wallen 2007)3432-MD 0.97 higher (4.45 lower to 6.39 higher)Low
MAS score, wrist flexors at 3 months
2 studies (Russo 2007, Wallen 2007)0/0 (0%)0/0 (0%)OR 0.1 (0.03 to 0.29)-Moderate
MAS score, wrist flexors at 4 months
1 study (Greaves 2004)0/0 (0%)0/0 (0%)OR 0.36 (0.07 to 1.87)-Low
MAS score, wrist flexors at 6 months
2 studies (Russo 2007, Wallen 2007)0/0 (0%)0/0 (0%)OR 0.2 (0.08 to 0.51)-Low
MTS score (mean change from baseline), wrist flexors at 4 months (better indicated by lower values)
1 study (Greaves 2004)1010-MD 10.56 lower (30.83 lower to 9.71 higher)Low
MTS score (mean final score), wrist flexors at 4 months, cycle 1 (better indicated by lower values)
1 study (Olesch 2010)11m11n-MD 18.5 lower (37.78 lower to 0.78 higher)*Moderate
MTS score (mean final score), wrist flexors, cycle 2 (better indicated by lower values)
1 study (Olesch 2010)11o11p-MD 18.5 lower (37.78 lower to 0.78 higher)*Moderate
MTS score (mean final score), wrist flexors, cycle 3 (better indicated by lower values)
1 study (Olesch 2010)11q11r-MD 20.9 lower (38.27 to 3.53 lower)*High
AROM wrist extension (change from baseline) at 3 months (better indicated by higher values)
1 study (Speth 2005)1010-MD 14.7 higher (7.92 lower to 37.32 higher)Moderate
AROM wrist extension (change from baseline) at 6 months (better indicated by higher values)
1 study (Speth 2005)1010-MD 15.6 higher (6.36 lower to 37.56 higher)Moderate
PROM wrist extension (change from baseline) at 3 months (better indicated by higher values)
1 study (Fehlings 2000)1415-MD 3.31 higher (4.7 lower to 11.32 higher)Low
PROM wrist extension (change from baseline) at 6 months (better indicated by higher values)
1 study (Fehlings 2000)1415-MD 0.07 lower (9.85 lower to 9.71 higher)Low
PROM palmar thumb abduction (change from baseline) at 3 months (better indicated by higher values)
1 study (Fehlings 2000)1415-MD 2.06 higher (4.69 lower to 8.81 higher)Low
PROM palmar thumb abduction (change from baseline) at 6 months (better indicated by higher values)
1 study (Fehlings 2000)1415-MD 1.56 higher (3.96 lower to 7.08 higher)Low

AROM active range of movement, CI confidence interval, MAS Modified Ashworth Scale, MD mean difference, MTS Modified Tardieu Scale, OR odds ratio, PROM passive range of movement, SD standard deviation

*

Calculated by the NCC-WCH

Data from Hoare 2010 Cochrane systematic review

a

Mean final score ± SD reported as 43.0 ± 45.7

b

Mean final score ± SD reported as 77.3 ± 39.3

c

Mean final score ± SD reported as 54.5 ± 44.1

d

Mean final score ± SD reported as 90.5 ± 40.3

e

Mean final score ± SD reported as 34.5 ± 48.0

f

Mean final score ± SD reported as 77.3 ± 56.2

g

Mean final score ± SD reported as 48.5 ± 37.2

h

Mean final score ± SD reported as 75.5 ± 31.7

i

Mean final score ± SD reported as 39.5 ± 40.6

j

Mean final score ± SD reported as 77.3 ± 22.8

k

Mean final score ± SD reported as 22.7 ± 33.2

l

Mean final score ± SD reported as 72.7 ± 28.7

m

Mean final score ± SD reported as 11.0 ± 17.4

n

Mean final score ± SD reported as 29.5 ± 27.6

o

Mean final score ± SD reported as 7.3 ± 9.3

p

Mean final score ± SD reported as 25.0 ± 30.7

q

Mean final score ± SD reported as 3.2 ± 7.2

r

Mean final score ± SD reported as 24.1 ± 28.5

See the complete GRADE Table K.7.1 which accompanies this abbreviated version.

From: 7, Botulinum toxin

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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