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Open Access Highly Accessed Study protocol

The early use of botulinum toxin in post-stroke spasticity: study protocol for a randomised controlled trial

Cameron Lindsay1*, Julie Simpson2, Sissi Ispoglou3, Steve G Sturman4 and Anand D Pandyan5

Author Affiliations

1 Physiotherapy Department, Sandwell and West Birmingham NHS Trust and School of Health and Rehabilitation, Keele University, Mackay Building, Keele, Staffordshire ST5 5BG, UK

2 Pharmacy Department, Sandwell and West Birmingham NHS Trust, City Hospital Birmingham, Dudley Road, Birmingham, West Midlands B18 7QH, UK

3 Department of Elderly Care, Sandwell and West Birmingham NHS Trust, City Hospital Birmingham, Dudley Road, Birmingham, West Midlands B18 7QH, UK

4 Department of Neurology, Sandwell and West Birmingham NHS Trust, City Hospital Birmingham, Dudley Road, Birmingham, West Midlands B18 7QH, UK

5 School of Health and Rehabilitation, Keele University, Mackay Building, Keele, Staffordshire ST5 5BG, UK

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Trials 2014, 15:12  doi:10.1186/1745-6215-15-12

Published: 8 January 2014

Abstract

Background

Patients surviving stroke but who have significant impairment of function in the affected arm are at more risk of developing pain, stiffness and contractures. The abnormal muscle activity, associated with post-stroke spasticity, is thought to be causally associated with the development of these complications. Treatment of spasticity is currently delayed until a patient develops signs of these complications.

Methods/Design

This protocol is for a phase II study that aims to identify whether using OnabotulinumtoxinA (BoNT-A) in combination with physiotherapy early post stroke when initial abnormal muscle activity is neurophysiologically identified can prevent loss of range at joints and improve functional outcomes.

The trial uses a screening phase to identify which people are appropriate to be included in a double blind randomised placebo-controlled trial. All patients admitted to Sandwell and West Birmingham NHS Trust Hospitals with a diagnosis of stroke will be screened to identify functional activity in the arm. Those who have no function will be appropriate for further screening. Patients who are screened and have abnormal muscle activity identified on EMG will be given electrical stimulation to forearm extensors for 3 months and randomised to have either injections of BoNT-A or normal saline. The primary outcome measure is the action research arm test - a measure of arm function. Further measures include spasticity, stiffness, muscle strength and fatigue as well as measures of quality of life, participation and caregiver strain.

Trial registrations

ISRCTN57435427, EudraCT2010-021257-39, NCT01882556

Keywords:
Spasticity; Stroke; OnabotulinumtoxinA; Contractures; Randomised controlled trial; Protocol