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.