COSMIN database

Systematic review of upper-limb function measurement methods in botulinum toxin intervention for focal spasticity

Ashford, S. and Turner-Stokes, L.
BACKGROUND AND PURPOSE: This paper aimed to select studies evaluating botulinum toxin (BoNT) intervention applied for upper-limb spasticity and from these identify outcome measures that are a) applicable in the hemiparetic upper limb and b) include evaluation of functional outcome in the context of everyday real-life activities.

METHODS: A systematic search was used to identify peer-reviewed papers evaluating BoNT intervention for focal spasticity management in the upper limb. From these papers, outcome evaluation methods were identified, which attempted to capture 'active function' improvement (functional use of the hand and/or arm) or passive function improvement (care for the affected limb, for example to maintain hygiene and dress or support the arm).

RESULTS: The search yielded 411 studies. Seventy papers were identified following a final review of the abstracts as potentially including evaluation of functional outcome (active and/or passive function). Following the review of the papers, a total of 22 studies contained specific methods for evaluating functional outcome in the upper limb.

DISCUSSION: Three different patient-focused methods to evaluate functional outcome following focal spasticity intervention using BoNT have been identified: 1) use of patient report of upper-limb items (including the Leeds Adult Spasticity Impact Scale and the Disability Assessment Scale), 2) use of a composite measure of function incorporating functional items and 3) Goal Attainment Scaling. None of these methods fully address evaluation of functional outcome in this context but may go some way to recording these improvements. An alternative or complementary measure, recently published, is the Arm Activity Measure for evaluation of active and passive function in this context. The Arm Activity Measure addresses active and passive function changes from the perspective of patients and carers and has been developed for application in this context.
Physiother Res Int
1471-2865 (Electronic)
Publication year:
Biological and physiological variables:
Biological and physiological variables
Symptom status:
Physical state
Functional status:
Physical functioning
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the circulatory system
Diseases of and symptoms related to the nervous system
Injury, poisoning and certain other consequences of external causes
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
4 - Performance-based tests
6 - Clinical rating scales
10MWT - 10 Meter Walk Test   
AQoL - Assessment of Quality of Life
ARAT - Action Research Arm Test   
BI - Barthel Index   
Carer burden scale
CMSA - Chedoke-McMaster Stroke Assessment
DAS - Disability Assessment Scale
Deep Tendon Reflexes
EMG - electromyography
EQ-5D - EuroQoL-5 Dimensions   
FAT - Frenchay Arm Test   
FIM - Functional Independence Measure (Also modified version exists)
GAS - Global Assessment Scale
GAS - Goal Attainment Scale   
Global Assessment of Outcome
Goniometry / Goniometer   
HADS - Hospital Anxiety and Depression Scale   
Isometric Muscle Strength
Jamar Dynamometer
Klein-Bell ADL Scale
MAL-28 - Motor Activity Log-28 item
MAL-5 - Motor Activity Log-5
MAL - Motor Activity Log   
MAS - Modified Ashworth Scale   
MI - Motricity Index   
mMAS - modified Motor Assessment Scale
Modified Frenchay Scale
MRC Scale - Medical Research Council Scale   
NHPT - Nine-Hole Peg Test   
NRS - Numeric Rating Scale   
OHS - Oxford Handicap Scale
passive and active range of movement MRC scale
PDS - Patient Disability Scale
Rating Global Benefit
RMA - Rivermead Motor Assessment
SA-SIP-30 - Stroke-Adapted Sickness Impact Profile   
SF-36 - 36-item Short Form Health Survey [alias: RAND-36][alias: Medical Outcomes Study (MOS) SF-36]]    |  | also see:
SIS - Stroke Impact Scale
Upper-body Dressing Time
VAS - Visual Analogue Scale