• Jörgen Borg, Anthony B Ward, Jörg Wissel, Jai Kulkarni, Mohamed Sakel, Per Ertzgaard, Per Åkerlund, Iris Reuter, Christoph Herrmann, Lalith Satkunam, Theodore Wein, Isabelle Girod, Nicola Wright, and BEST Study Group.
• Department of Clinical Sciences, Karolinska Institutet, Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden. Jorgen.Borg@ki.se
• J Rehabil Med. 2011 Jan 1; 43 (1): 15-22.

ObjectiveThis report describes the design of a study aiming to provide evidence for the extended use of botulinum toxin A in focal post-stroke upper and lower limb spasticity and to evaluate the impact of incorporating botulinum toxin treatment into the rehabilitation of patients with spasticity.DesignInternational, prospective, randomized, double-blind, placebo-controlled study with an open-label extension.MethodsApproximately 300 adults with a stroke occurring ≥ 3 months before screening, presenting with symptoms and signs of an upper motor neuron syndrome and focal spasticity-related functional impairment, were randomized to botulinum toxin (BOTOX®, Allergan Inc.) + standard care or placebo + standard care. Study medication was administered at baseline and again at Week 12 if required, with follow-up to 52 weeks. The primary endpoint was the number of patients who achieved their investigator-rated principal active functional goal (as measured by Goal Attainment Scaling), at 10 weeks after the second injection (Weeks 22-34) or at the 24-week visit if no second injection was administered. Secondary endpoints included changes from baseline in level of goal achievement, health-related quality of life and resource utilization.ConclusionBotulinum toxin A Economic Spasticity Trial (BEST) will provide information regarding clinical and cost-effectiveness of botulinum toxin + standard care vs standard care alone in patients with upper and/or lower limb post-stroke spasticity typically seen in clinical practice.Trial RegistrationClinicalTrials.gov number NCT-00549783.

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