Abstract
Existing functional evaluation tools do not accurately reveal the improved function following botulinum toxin A (BTX-A) injection for post-stroke upper limb spasticity. With the aim of developing an alternate method of measuring functional improvement following BTX-A injection, this study tested the feasibility, validity and reliability of video clip analysis performed by the clinicians. Seventy-nine patients administered BTX-A due to post-stroke upper limb spasticity, were retrospectively evaluated using video clip analysis. Pre- and post-injection video clips recorded at 1-month intervals were randomly allocated and sent to three blinded physician evaluators who were asked to choose the one that seemed more improved in terms of hand motion and associated upper limb reaction during gait. The three physicians chose the post-injection video clip as depicting improved hand motion (82.3%, 79.7%, and 72.2%) and associated upper limb reaction during gait (73.4%, 70.9%, and 70.9%). Kappa and intraclass correlation coefficient as a measure of interrater reliability among the three physicians was 0.86 and 0.79 for the hand, and 0.92 and 0.92 for associated upper limb reaction during gait, respectively. The percent overall agreement of the physicians was 78.1% and 71.7% for hand function and associated upper limb reaction, respectively. Retrospective pre- and post-BTX-A injection video clip analyses is a clinically feasible alternative method to evaluate the improvement following BTX-A injection for post-stroke upper limb spasticity, especially in busy clinical practice setting.
Highlights
Stroke is a leading cause of mortality and long-term morbidity [1]
We investigated the use of video clips as a new evaluation tool for analyzing pre- and post-botulinum toxin A (BTX-A)
The study was not designed to demonstrate the beneficial effect of BTX-A injection for post-stroke spastic upper limb function, but rather to demonstrate the feasibility of physician video clip analysis as an alternative outcome measure for assessing improvement following BTX-A injection by estimating its validity and reliability
Summary
Americans a year [2] and many stroke survivors experience residual disability with limited functional recovery of the upper limbs. Apart from loss of function due to paresis, spasticity may be one of major contributing factors to disability [3]. A majority of stroke survivors exhibit persisting motor deficits and various manifestations of the upper motor neuron syndrome caused by spasticity [1]. Spasticity develops in various upper motor neuron disorders such as stroke, spinal cord injury, multiple sclerosis and cerebral palsy [6]. Spastic hypertonia causes restricted joint range of motion, excessive force on joints, and pain, leading to compensatory abnormal posture, functional limitations in activities of daily living and ambulation, and increased care giver burden [7]
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