Effects of lower limb botulinum toxin injections on gait functional outcomes in stroke survivors: a systematic review and meta-analysis.
Chiara De Santis, Stefano Doronzio, Maria A Szczepanska and 7 others
PMID 40856376WHAT IT FOUND
Lower limb botulinum toxin injections do not improve walking speed in chronic stroke survivors.
While the treatment effectively reduces muscle spasticity, this tone reduction does not translate into better gait function. Clinicians should not expect functional walking improvements from these injections alone.
Key findings
01Meta-analysis of four studies showed no difference in gait speed between botulinum toxin and placebo/no treatment at one and three months post-injection.
02The largest included trial, with 468 participants, reported no significant difference in gait speed between treated and control groups, though specific values were not reported for pooling.
03Botulinum toxin injections effectively reduce muscle spasticity, but this reduction in muscle tone does not result in functional improvement in walking speed.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Included studies had heterogeneous populations, varying from subacute to chronic stroke, and different control conditions (placebo vs. no treatment). The largest trial did not report raw gait speed values, preventing its inclusion in the meta-analysis. Most studies had small sample sizes, with one large trial dominating the total participant count. Concomitant physiotherapy was inconsistently reported or allowed, making it difficult to isolate the effect of the toxin alone. Risk of bias was present in several included studies, particularly regarding blinding of assessors.
Declared interests
The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.
The easy way to misread this
Do not assume that reduced muscle spasticity leads to better walking. The evidence shows that while botulinum toxin effectively lowers tone in the lower limbs, this does not translate to improved gait speed or function in chronic stroke survivors.