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Outcome Measures Used in Studies of Botulinum Toxin in Childhood Cerebral Palsy
Journal of Child Neurology, 10/12/09

Baird MW et al. – A total of 67% of all outcomes demonstrated a significant difference. This review illustrates that few studies provide a high level of evidence and that outcomes focus on arenas such as spasticity or range of motion rather than activity or participation domains such as walking.

Exclusive Author Commentary
Micah W. Baird, 10/12/09

There is a preponderance of body structure and function measures, as well as gait analysis parameters, in studies of botulinum toxin use in childhood cerebral palsy. The literature has demonstrated that botulinum toxin is effective in the domains where its mechanism of action at the neuromuscular junction would be expected to have impact. In this population, there has been no investigation of how changes in the body structure and function domain, which is directly affected by the botulinum toxin injections, affect the activity and participation domains. Since botulinum toxin is often employed with the hope of affecting activity and participation domains, evaluation of the intervention’s impact on these domains that are indirectly affected is still needed. The quality of evidence in this series of articles is concerning. Very few studies demonstrated level I evidence. In addition, there is an inverse relationship between the quality of evidence and the likelihood of obtaining significant results. The significance of evidence presented in the multitude of lower quality articles increases the risk of over-interpretation of the results. The use of botulinum toxin in cerebral palsy needs further study. Now that botulinum toxin’s effects in the body structure and function domains are established, further evaluation should focus on clinically important outcomes in the activity and participation domains and these studies must utilize standardized measures. With improved understanding of the scope of effects of botulinum toxin, care for children with cerebral palsy can ultimately be better targeted to obtain more favorable outcomes.

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