Objective

To evaluate the effectiveness of botulinum toxin A (BTX-A) in the treatment of hemiplegic shoulder pain.

Data Sources

PubMed, EMBASE, Elsevier, Springer, Cochrane Library, Physiotherapy Evidence Database, CNKI, and VIP were researched from the earliest records to September 1, 2020.

Study Selection

Randomized controlled trials that compared shoulder BTX-A injections vs a control intervention in patients with a history of hemiplegic shoulder pain after stroke were selected. Among the 620 records screened, 9 trials with 301 eligible patients were included.

Data Extraction

Outcome data were pooled according to follow-up intervals (1, 2, 4, and 12 wk). The primary evaluation indices were pain reduction (visual analog scale [VAS] score) and range of motion (ROM) improvement. The second evaluation indices were upper limb functional improvement, spasticity improvement, and incidence of adverse events. Cochrane risk-of-bias was used to assess the methodological quality of studies independently by 2 evaluators.

Data Synthesis

Meta-analysis revealed a statistically significant decrease in the VAS score in the BTX group vs the control group at 1, 4, and 12 weeks postinjection (wk 1: standardized mean difference [SMD], 0.91; 95% confidence interval [CI], 0.27 to 1.54; wk 4: SMD, 1.63; 95% CI, 0.76 to 2.51; wk 12: SMD, 1.96; 95% CI, 1.44 to 2.47). Furthermore, the meta-analysis demonstrated a statistically significant increase in abduction at 1, 4, and 12 weeks postinjection (wk 1: SMD, 3.71; 95% CI, 0 to 7.41; wk 4: SMD, 8.8; 95% CI, 2.22 to 15.37; wk 12: SMD, 19.59; 95% CI, 9.05 to 30.13) and external rotation at 1, 2, 4 weeks postinjection (wk 1: SMD, 5.67; 95% CI, 0.88 to 10.47; wk 2: SMD, 9.62; 95% CI, 5.57 to 13; wk 4: SMD, 6.89; 95% CI, 2.45 to 11.33) in the BTX group.

Conclusions

BTX-A injection provided greater analgesic effects and increased shoulder abduction and external rotation ROM compared with steroid or placebo injection for the treatment of HSP.

中文翻译：

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肉毒杆菌毒素 A 治疗偏瘫肩痛的有效性：系统评价和 Meta 分析

客观的

评估肉毒杆菌毒素 A (BTX-A) 治疗偏瘫肩痛的有效性。

数据源

PubMed、EMBASE、Elsevier、Springer、Cochrane Library、Physiotherapy Evidence Database、CNKI、VIP从最早的记录到2020年9月1日进行了研究。

研究选择

选择了在有中风后偏瘫肩痛病史的患者中比较肩部 BTX-A 注射与对照干预的随机对照试验。在筛选的 620 条记录中，纳入了 9 项试验，涉及 301 名符合条件的患者。

数据提取

根据随访间隔（1、2、4 和 12 周）汇总结果数据。主要评估指标是疼痛减轻（视觉模拟量表 [VAS] 评分）和运动范围 (ROM) 改善。第二个评价指标为上肢功能改善、痉挛改善和不良事件发生率。Cochrane 偏倚风险用于由 2 名评估者独立评估研究的方法学质量。

数据综合

荟萃分析显示，在注射后 1、4 和 12 周，BTX 组的 VAS 评分与对照组相比显着降低（第 1 周：标准化平均差 [S​​MD]，0.91；95% 置信区间 [CI]， 0.27 至 1.54；第 4 周：SMD，1.63；95% CI，0.76 至 2.51；第 12 周：SMD，1.96；95% CI，1.44 至 2.47）。此外，荟萃分析表明，注射后 1、4 和 12 周外展有统计学意义的增加（第 1 周：SMD，3.71；95% CI，0 至 7.41；第 4 周：SMD，8.8；95% CI，2.22至 15.37；第 12 周：SMD，19.59；95% CI，9.05 至 30.13）和注射后 1、2、4 周的外旋（第 1 周：SMD，5.67；95% CI，0.88 至 10.47；SMD，周， 9.62；95% CI，5.57 至 13；第 4 周：SMD，6.89；95% CI，2.45 至 11.33）在 BTX 组中。

结论

与类固醇或安慰剂注射治疗 HSP 相比，BTX-A 注射提供了更大的镇痛效果并增加了肩外展和外旋 ROM。