• Jennifer A Baker and Gavin Pereira.
• South Hams Physiotherapy Ltd, Ivybridge, UK jennyjas1@yahoo.co.uk.
• Clin Rehabil. 2015 Aug 1; 29 (8): 731-40.

ObjectivesA systematic review and meta-analysis using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach; evaluating Botulinum Toxin type A efficacy on improving ease of care in the upper/lower limb.Data SourcesPubmed, Cinahl, Amed, Embase and Cochrane databases. English Language. Search to July 2014.Review MethodsAll randomized, placebo controlled trials on adults with difficulty in caring for the upper/lower limb resulting from spasticity of any origin and treated with a single dose of Botulinum Toxin A. Evidence quality was assessed by GRADE.ResultsA total of 32 studies were reviewed. Meta-analysis was carried out on 11 upper limb and three lower limb studies. Evidence quality for the upper limb was moderate. A significant result for Botulinum Toxin A was found at four to 12 weeks for the upper limb (SMD 0.80, CI 0.55, 1.06, p < 0.0001). The effects were maintained for up to six months (SMD 0.48, CI 0.34, 0.62, p < 0.0001). Evidence quality was very low for the lower limb. Meta-analysis was only possible for global assessment of benefit. No significant effect was found. (PatientRR 1.37 CI (0.94, 2.00) p = 0.11; clinician: RR 1.06 (0.84, 1.34) p = 0.60.)ConclusionBotulinum Toxin A improves ease of care in the upper limb for up to six months. No conclusion can be drawn for the lower limb.© The Author(s) 2014.

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