Efficacy of botulinum toxin for poststroke lower limb: a systematic review and meta-analysis.

The review only included 7 studies for the meta-analysis, which limits the statistical power and generalizability. There was significant heterogeneity in the studies regarding the specific muscles injected, doses used, and the baseline severity of spasticity. The strict exclusion of trials where botulinum toxin was combined with other therapies (like robotics or electrical stimulation) means the results may not reflect typical real-world practice where such combinations are common. Some included studies had limitations in blinding of participants or outcome assessors, which could introduce bias.

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Do not interpret the lack of functional gain as evidence that botulinum toxin is ineffective. The study tested the drug in isolation; in clinical practice, it is almost always used to enable active rehabilitation. The failure of the injection alone to improve walking does not mean the injection is useless, but rather that it is not a standalone treatment for mobility.