Prognosis prediction of the effect of botulinum toxin therapy and intensive rehabilitation on the upper arm function in post-stroke patients using hierarchical cluster analysis

Abstract

Purpose

We analysed the effect of botulinum neurotoxin A therapy (BoNT-A) with intensive rehabilitation on the upper limb (UL) spasticity in post-stroke patients by classifying function by UL movement and examining differences in functional improvement.

Materials and methods

In this non-randomized, controlled study. The patient function was classified into groups from the score of the sub-categories of the Fugl–Meyer Assessment (FMA-UE) before treatment in the Intervention group by hierarchical cluster analysis.

Results

A total of 139 patients in the Intervention group were classified into six groups. All groups showed a significant improvement in FMA-UE after the intervention. In the group scoring 19–31 points on the FMA-UE and with the voluntary movement of shoulder, elbow, forearm, and finger, a significant improvement was observed compared to the Control group. Further, in the group scoring 26–47 points on the FMA-UE and with the voluntary movement of shoulder, elbow, forearm, wrist, and finger, a significant improvement was observed compared to the Control group.

Conclusions

In this study, BoNT-A and intensive rehabilitation showed improvement in spasticity and UL function. A high therapeutic effect is expected in patients with moderate impairment levels who have voluntary movement in whole UL or in UL except for the wrist.

IMPLICATIONS FOR REHABILITATION

• Hierarchical cluster analysis focusing on the Fugl–Meyer Assessment of the Upper Extremity sub-categories may be useful for studies aimed to improve the upper arm function.

• Botulinum Neurotoxin A therapy (BoNT-A) and intensive rehabilitation in post-stroke patients showed improvement in spasticity and upper arm function.

• The degree of the upper arm function before the intervention may affect the improvement effect of BoNT-A and intensive rehabilitation.

• In the motor function, the post-stroke patients with a moderate impairment level who have voluntary movement of the whole upper limb or upper limb except for the wrist are most likely to receive these therapeutic effects.

Keywords:

• Stroke; spasticity; Botulinum toxin therapy; upper limb; hierarchical cluster analysis

Disclosure statement

No potential conflict of interest was reported by the author(s).