Long-Term Observational Results from the ASPIRE Study: OnabotulinumtoxinA Treatment for Adult Lower Limb Spasticity.
Alberto Esquenazi, Ganesh Bavikatte, Daniel S Bandari and 7 others
PMID 33151636WHAT IT FOUND
In real-world practice, botulinum toxin injections for lower limb spasticity improved walking, dressing, and pain over two years, with high satisfaction.
However, nearly 40% of patients dropped out, and pain data relied on a minority of responses, so this describes typical care rather than proof of efficacy.
Key findings
01Clinician-reported disability improved significantly for dressing, limb posture, mobility, and pain, but not hygiene.
02Patient-reported pain scores improved significantly, but data was only available from about half of the patients.
03Treatment was highly individualized, with clinicians frequently adjusting muscles targeted or dosage between sessions.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
There was no control group, so it is impossible to know if improvements were due to the injection, natural variation, or other concurrent therapies. Nearly 40% of patients dropped out, and the most common reason was that the treatment did not work, which may bias the remaining results to look more positive. Patient-reported data on pain and satisfaction had low response rates (around 40-52%), meaning the findings may not represent the entire group. Patients often received treatment for upper limb spasticity as well, so improvements in overall quality of life or pain may not be solely attributable to the lower limb injections.
Declared interests
The study was sponsored by AbbVie (the manufacturer of onabotulinumtoxinA), though the abstract notes that financial support was not provided for treatment costs and clinicians were not compensated beyond administrative costs.
The easy way to misread this
Do not interpret the high satisfaction and improved scores as definitive proof that the injections caused these benefits, as there was no comparison group and many patients who felt the treatment failed left the study.