Composite active range of motion (CXA) and relationship with active function in upper and lower limb spastic paresis.
Nicolas Bayle, Pascal Maisonobe, Romain Raymond and 2 others
PMID 32336148WHAT IT FOUND
Composite active range of motion tracked active function after botulinum toxin for spastic paresis only weakly to moderately.
Range peaked at week 4, function at week 12. It may help measure movement, but it is not a simple stand-in for functional change.
Key findings
01Composite active range of motion correlated with active function, but the correlations were weak to moderate.
02Changes in composite active range and changes in active function did not correlate consistently; significant change correlations occurred only in the upper limb at cycle 2 week 12 and cycle 3 week 4.
03In the double-blind upper limb study, composite active range improved more with abobotulinumtoxinA than placebo at week 4; the lower limb study did not show the same marked difference.
STILL TO COME
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What it does not show
This was a post hoc analysis of two earlier trials, not a new randomized trial designed to test composite active range of motion. The composite measure included only a small number of muscles and may miss other clinically relevant movement limitations, such as shoulder, pronator or proximal lower-limb overactivity. Open-label analyses were limited to patients with data at both week 4 and week 12, and cycle 4 was not analyzed because patient numbers were too low. The assessment period was short, and motor control may need more than 12 weeks to adapt after a muscle-weakening treatment. The correlations between changes in composite range and changes in function were weak or inconsistent, so the measure did not reliably track functional change.
Declared interests
The analysis was sponsored by Ipsen, the company named as the source of abobotulinumtoxinA (Dysport). Authors included Ipsen employees, an employee of a subcontractor to Ipsen, and a researcher with Ipsen research grants, consultancy fees, and investigator roles.