Table 7.3Evidence profile for botulinum toxin type A and physical therapy compared with physical therapy alone; upper limb; functioning assessment

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

(95% CI)
Absolute

(95% CI)
GAS score (change from baseline, parental report at 3 months, better indicated by higher values)
4 studies (Boyd 2004; Lowe 2006; Russo 2007; Wallen 2007)7775-MD 8.52 higher (4.42 to 12.62 higher)High
GAS score (change from baseline, parental report at 4 months, better indicated by higher values)
1 study (Greaves 2004)1010-MD 9.21 higher (1.06 to 17.36 higher)Low
GAS score (change from baseline, parental report at 6 months (better indicated by higher values)
3 studies (Lowe 2006; Russo 2007; Wallen 2007)6260-MD 5.04 higher (0.75 lower to 10.83 higher)Moderate
GAS T-Score (final score comparison, cycle 1, better indicated by higher values)
1 study (Olesch 2010)11a11b-MD 6.0 higher (2.32 lower to 14.32 higher)*Moderate
GAS T-score (final score comparison), cycle 2, better indicated by higher values)
1 study (Olesch 2010)11c11d-MD 7.7 higher (1.16 lower to 16.56 higher)*Moderate
GAS T-score (final score comparison, cycle 3, better indicated by higher values)
1 study (Olesch 2010)11811f-MD 4.9 higher (2.11 lower to 11.91 higher)*Moderate
GAS T-score over whole year (better indicated by higher values)
1 study (Olesch 2010)11g11h-MD 7 higher (0.59 to 13.41 higher)*Moderate
COPM-P score (change from baseline at 3 months, better indicated by higher values)
3 studies (Boyd 2004; Lowe 2006; Wallen 2007)5653-MD 0.77 higher (0.23 to 1.31 higher)Moderate
COPM-P score (change from baseline at 4 months, better indicated by higher values)
1 study (Greaves 2004)1010-MD 0.6 higher (0.68 lower to 1.88 higher)Low
COPM-P score (change from baseline at 4 months, cycle 1 change score, better indicated by higher values)
1 study (Olesch 2010)11i11j-MD 0.7 higher (0.32 lower to 1.72 higher)*Moderate
COPM-P score (change from baseline, cycle 2, better indicated by higher values)
1 study (Olesch 2010)11k11l-MD 0.9 higher (0.1 to 1.7 higher)*Moderate
COPM-P score (change from baseline, cycle 3, better indicated by higher values)
1 study (Olesch 2010)11m11n-MD 1.4 higher (0.35 to 2.45 higher)*Moderate
COPM-P score (change from baseline over whole year, better indicated by higher values)
1 study (Olesch 2010)11o11p-MD 0.8 higher (0.04 lower to 1.64 higher)*Moderate
COPM-P score (change from baseline at 6 months, better indicated by higher values)
2 studies (Lowe 2006; Wallen 2007)4138-MD 0.4 higher (0.3 lower to 1.09 higher)Moderate
PEDI functional skills scale, scaled score (change from baseline at 3 months, better indicated by higher values)
3 studies Boyd 2004; Fehlings 2000; Wallen 2007)4947-MD 0.6 higher (1.44 lower to 2.63 higher)Low
PEDI functional skills scale, scaled score (change from baseline at 6 months, better indicated by higher values)
2 studies (Fehlings 200; Wallen 2007)3432-MD 1.09 higher (1.7 lower to 3.88 higher)Low
PEDI caregiver assistance scale, scaled score (change from baseline at 3 months, better indicated by higher values)
1 study (Wallen 2007)2017-MD 6.3 lower (14.68 lower to 2.08 higher)Moderate
PEDI caregiver assistance scale, scaled score (change from baseline at 6 months, better indicated by higher values)
1 study (Wallen 2007)2017-MD 4.4 lower (13.38 lower to 4.58 higher)Moderate
QUEST parent score (change from baseline at 3 months, better indicated by higher values)
3 studies (Fehlings 2000; Lowe 2006; Wallen 2007)4242-MD 9.19 higher (4.84 to 13.54 higher)Moderate
QUEST parent score (change from baseline at 4 months, better indicated by higher values)
1 study (Greaves 2004)1010-MD 4,42 lower (9.98 lower to 1.14 higher)Low
QUEST parent score (change from baseline at 6 months, better indicated by higher values)
3 studies (Fehlings 2000; Lowe 2006; Wallen 2007)4242-MD 2.93 higher (1.58 lower to 7.45 higher)Low
QUEST total score (final score comparison), cycle 1 (better indicated by higher values)
1 study (Olesch 2010)11q11r-MD 5.50 higher (5.37 lower to 16.37 higher)*Moderate
QUEST total score (final score comparison), cycle 2 (better indicated by higher values)
1 study (Olesch 2010)11s11t-MD 7.60 higher (2.42 lower to 17.62 higher)*Moderate
QUEST total score (final score comparison), cycle 3 (better indicated by higher values)
1 study (Olesch 2010)11u11v-MD 6.70 higher (1.58 lower to 14.98 higher)*Moderate

COPM-P Canadian Occupational Performance Measure – Performance, GAS Goal Attainment Scaling, PEDI Paediatric Evaluation of Disability Inventory, QUEST Quality of Upper Extremity Skills Test, SD standard deviation

*

Calculated by the NCC-WCH

Data from Hoare 2010 Cochrane systematic review

a

Mean final score ± SD reported as 54.1 ± 9.8

b

Mean final score ± SD reported as 48.1 ± 10.1

c

Mean final score ± SD reported as 55.0 ± 4.3

d

Mean final score ± SD reported as 47.3 ± 11.6

e

Mean final score ± SD reported as 54.9 ± 9.5

f

Mean final score ± SD reported as 50.0 ± 7.1

g

Mean final score ± SD reported as 55.8 ± 6.6

h

Mean final score ± SD reported as 48.8 ± 8.6

i

Mean change from baseline ± SD = 2.4 ± 1.0

j

Mean change from baseline ± SD = 1.7 ± 1.4

k

Mean change from baseline ± SD = 2.7 ± 0.9

l

Mean change from baseline ± SD = 1.8 ± 1.0

m

Mean change from baseline ± SD = 3.0 ± 1.3

n

Mean change from baseline ± SD = 1.6 ± 1.2

o

Mean change from baseline ± SD = 2.5 ± 1

p

Mean change from baseline ± SD = 1.7 ± 0.6

q

Mean final score ± SD reported as 76.3 ± 13.2

r

Mean final score ± SD reported as 70.8 ± 12.8

s

Mean final score ± SD reported as 76.9 ± 10.4

t

Mean final score ± SD reported as 69.3 ± 13.4

u

Mean final score ± SD reported as 79.6 ± 8.0

v

Mean final score ± SD reported as 72.9 ± 11.5

See the complete GRADE Table K.7.3 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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