DOES CASTING AFTER BOTULINUM TOXIN INJECTION IMPROVE OUTCOMES IN ADULTS WITH LIMB SPASTICITY? A SYSTEMATIC REVIEW
Jordan Farag, MD1,2 Rajiv Reebye, MD1,2, Carl Ganzert, MSc5 and Patricia Mills, MD, MHSc1–4
Spasticity is a common and problematic consequence of neurological conditions affecting the brain and spinal cord. It is characterized by intermittent or sustained involuntary muscle activation that can limit function and quality of life. Intramuscular injection with botulinum toxin is a useful treatment in such patients in order to weaken the spastic muscle. This study reviewed the published evidence for the use of casting after botulinum toxin injection for limb spasticity in adults
Objective: To determine current evidence for casting as an adjunct therapy following botulinum toxin injection for adult limb spasticity.
Design: The databases MEDLINE, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials were searched for English language studies from 1990 to August 2018. Full-text studies using a casting protocol following botulinum toxin injection for adult participants for limb spasticity were included. Studies were graded according to Sackett’s levels of evidence, and outcome measures were categorized using domains of the International Classification of Disability, Functioning and Health. The review was prepared and reported according to PRISMA guidelines.
Results: Five studies, involving a total of 98 participants, met the inclusion criteria (2 randomized controlled trials, 1 pre-post study, 1 case series and 1 case report). Casting protocols varied widely between studies; all were on casting of the lower limbs. There is level 1b evidence that casting following botulinum toxin injection improves spasticity outcomes compared with stretching and taping, and that casting after either botulinum toxin or saline injections is better than physical therapy alone.
Conclusion: The evidence suggests that adjunct casting of the lower limbs may improve outcomes following botulinum toxin injection. Casting protocols vary widely in the literature and priority needs to be given to future studies that determine which protocol yields the best results.