- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03664375
Impact Of Physiotherapy And Botox In Improving Functional Outcomes Among Post Stroke Focal Dystonia Patients
September 7, 2018 updated by: Muhammad Umar, Isra University
Impact Of Physiotherapy And Botulinum Toxin Type-A In Improving Functional Outcomes In Upper Limb Focal Dystonia Among Post Stroke Patients
This study was conducted to assess the combine role of Physiotherapy by providing task specific trainings and Botulinum Toxin Type A in improving the functional outcomes of upper limb in post stroke patients with focal hand dystonia.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
Post-stroke hemiparesis, with dystonia, is a major cause of disability.
Dystonia can hinder the functional activities making patient dependent on others for performance of daily living activities.
Dystonia not only limits the physical activity of the patient but also affects their quality of life significantly.
Various treatment protocols have been used in the literature for treatment of focal hand dystonia in the past including deep brain stimulation, kinesio taping, sensory oriented training, splinting, extracorporeal shock wave therapy and botox.
Out of these Botox has gained much importance but it results only in improving the passive range of motion and has no consensus in improving the active range of motion and functional independence of the patient.
The current study was planned to determine the effects of botulinum toxin type A combined with task-specific therapy, for post-stroke focal dystonia of upper limb.
Study Type
Interventional
Enrollment (Actual)
39
Phase
- Not Applicable
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 65 years (ADULT, OLDER_ADULT)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Patients having first episode of unilateral stroke
- At least 6 months of post stroke duration presenting with post stroke focal dystonia of the upper limb.
- No previous exposure of the affected hand of Botox.
- Reduced upper limb functions
- Both genders will be included equally.
Exclusion Criteria:
- Significant speech or cognitive impairment which impedes the ability to perform the assessment.
- Other significant upper limb impairment e.g. fracture or frozen shoulder within 6 months.
- Severe arthritis, amputation, evidence of fixed contracture, pregnancy or lactating womens.
- Other diagnosis likely to interfere with rehabilitation or outcome assessments, e.g. blind, malignancy,
- Other conditions which may contribute to upper limb spasticity, e.g. multiple sclerosis, cerebral palsy.
- Use of botulinum toxin to the upper limb in the previous 4 months.
- Contraindications to intramuscular injection.
- Contraindications /allergy to botulinum toxin type A, which include bleeding disorders, myasthenia gravis and concurrent use of aminoglycosides.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Experimental Group
The experimental group received botulinum toxin type A. After one week of Botox administration, a specially made task specific training program was started for these patients.
It was provided for a duration of one hour and for three times per week for a total of 12 weeks by a trained physiotherapist.
|
All patients in the experimental group received a BoNT-A injection.
The injected total dose for individual patient in the experimental group was 100 units which is equivalent to approximately 300-500 Units of Dysport (the other type of BoNT-A available).
The Botox was injected by the neurophysician intramuscularly using insulin U100 syringe and determination of muscles for injection was assessed clinically.
Task specific training is the repetition of a specific task until expertise is reached.
More challenging tasks are added as a means of progression
|
PLACEBO_COMPARATOR: Control Group
The control group received only task specific training program with the same protocol as for the experimental group; for a duration of one hour and for three times per week up to a total of 12 weeks by a trained physiotherapist
|
Task specific training is the repetition of a specific task until expertise is reached.
More challenging tasks are added as a means of progression
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Action Research Arm Test (ARAT):
Time Frame: 12 weeks
|
It assessed specific changes in limb function by 19 items grouped in four subscales.
The total score ranged from 0 to 57.
The lower score indicated no movement and upper score indicated normal performance of the patient.
|
12 weeks
|
MOTOR ASSESSMENT SCALE (MAS)
Time Frame: 12 weeks
|
It was a performance-based scale, based on a task-oriented approach to evaluate and assesses performance of functional tasks rather than isolated patterns of movement.
All items were assessed using a 7-point scale from 0 - 6.
A score of 6 indicated optimal motor behavior.
|
12 weeks
|
WOLF MOTOR FUNCTION TEST (WMFT)
Time Frame: 12 weeks
|
It quantified motor ability through timed functional tasks.
It used a 6-point ordinal scale with "0" = "does not attempt with the involved arm" to "5" = movement appears to be normal."
|
12 weeks
|
FUGL- MEYER ASSESSMENT TEST
Time Frame: 12 weeks
|
It was a performance-based impairment index to measure motor functioning.
The total score possible was from 0 - 66, with higher function showing the improved level of independence
|
12 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Severity Of Dystonia
Time Frame: 12 weeks
|
The Arm Dystonia Disability Scale: The severity of dystonia was assessed using 0 (None) to 3 (Marked Difficulty in performing activity
|
12 weeks
|
Stroke Specific Quality Of Life
Time Frame: 12 weeks
|
The stroke specific Quality Of Life was administered to patients which rated their Quality of life
|
12 weeks
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (ACTUAL)
November 1, 2015
Primary Completion (ACTUAL)
August 1, 2016
Study Completion (ACTUAL)
December 1, 2016
Study Registration Dates
First Submitted
September 5, 2018
First Submitted That Met QC Criteria
September 7, 2018
First Posted (ACTUAL)
September 10, 2018
Study Record Updates
Last Update Posted (ACTUAL)
September 10, 2018
Last Update Submitted That Met QC Criteria
September 7, 2018
Last Verified
September 1, 2018
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Central Nervous System Diseases
- Nervous System Diseases
- Neurologic Manifestations
- Movement Disorders
- Dyskinesias
- Dystonia
- Dystonic Disorders
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Peripheral Nervous System Agents
- Cholinergic Agents
- Membrane Transport Modulators
- Acetylcholine Release Inhibitors
- Neuromuscular Agents
- Botulinum Toxins
- Botulinum Toxins, Type A
- abobotulinumtoxinA
Other Study ID Numbers
- IIRS-IUISB/PHD/008
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
YES
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
- CSR
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Focal Hand Dystonia
-
Duke UniversityAmerican Academy of NeurologyRecruiting
-
National Institute of Neurological Disorders and...Active, not recruitingDystonia | Focal Dystonia | Musician's DystoniaUnited States
-
National Institute of Neurological Disorders and...Completed
-
University of MinnesotaCompleted
-
National Institute of Neurological Disorders and...Completed
-
National Institute of Neurological Disorders and...Completed
-
National Institute of Neurological Disorders and...Prachaya Srivanitchapoom, MDTerminated
-
University of MinnesotaNational Institutes of Health (NIH); National Center for Research Resources... and other collaboratorsCompletedDystonia, Focal, Task-specificUnited States
-
Kristina SimonyanNational Institute of Neurological Disorders and Stroke (NINDS)CompletedSpasmodic Dysphonia | Writer's Cramp | Singer's Dystonia | Musician's Focal Hand DystoniaUnited States
-
National Institute of Neurological Disorders and...Completed
Clinical Trials on Botulinum toxin type A
-
AllerganTerminatedOveractive BladderSerbia, Turkey, Greece, Egypt, Lebanon, India
-
Daewoong Pharmaceutical Co. LTD.Completed
-
AllerganCompletedOveractive BladderPortugal, South Africa, Netherlands, Canada, Singapore, Brazil, United States, Taiwan, Italy, United Kingdom, France, Spain
-
AllerganCompletedOveractive BladderUnited Kingdom, Belgium, New Zealand, France, Russian Federation, Czech Republic, United States, Germany, Austria, Poland, Slovakia, Ukraine, Canada, Australia
-
Mentor Worldwide, LLCSynteract, Inc.CompletedGlabellar RhytidesUnited States
-
Brazilan Center for Studies in DermatologyCompletedWrinkles in Frontal AreaBrazil
-
HugelCompletedBenign Masseteric HypertrophyKorea, Republic of
-
Mentor Worldwide, LLCSynteract, Inc.CompletedGlabellar Rhytides | Frown Lines Between the EyebrowsUnited States
-
Seton Healthcare FamilyCompleted
-
Medy-ToxCompletedCervical Dystonia