{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T16:45:51Z","timestamp":1781541951440,"version":"3.54.5"},"reference-count":47,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T00:00:00Z","timestamp":1640217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Identifying patients who can gain minimal clinically important difference (MCID) in active motor function in the affected upper extremity (UE) after a botulinum toxin A (BoNT-A) injection for post-stroke spasticity is important. Eighty-eight participants received a BoNT-A injection in the affected UE. Two outcome measures, Fugl\u2013Meyer Assessment Upper Extremity (FMA-UE) and Motor Activity Log (MAL), were assessed at pre-injection and after 24 rehabilitation sessions. We defined favorable response as an FMA-UE change score \u22655 or MAL change score \u22650.5.Statistical analysis revealed that the time since stroke less than 36 months (odds ratio (OR) = 4.902 (1.219\u201313.732); p = 0.023) was a significant predictor of gaining MCID in the FMA-UE. Medical Research Council scale -proximal UE (OR = 1.930 (1.004\u20133.710); p = 0.049) and post-injection duration (OR = 1.039 (1.006\u20131.074); p =0.021) were two significant predictors of MAL amount of use. The time since stroke less than 36 months (OR = 3.759 (1.149\u201312.292); p = 0.028), naivety to BoNT-A (OR = 3.322 (1.091\u201310.118); p = 0.035), and education years (OR = 1.282 (1.050\u20131.565); p = 0.015) were significant predictors of MAL quality of movement. The findings of our study can help optimize BoNT-A treatment planning.<\/jats:p>","DOI":"10.3390\/toxins14010013","type":"journal-article","created":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T21:40:21Z","timestamp":1640295621000},"page":"13","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Predictors of Clinically Important Improvements in Motor Function and Daily Use of Affected Arm after a Botulinum Toxin A Injection in Patients with Chronic Stroke"],"prefix":"10.3390","volume":"14","author":[{"given":"Jen-Wen","family":"Hung","sequence":"first","affiliation":[{"name":"Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan"},{"name":"School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Chi","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5540-2280","authenticated-orcid":false,"given":"Yi-Ju","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya-Ping","family":"Pong","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan"},{"name":"School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ku-Chou","family":"Chang","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"},{"name":"Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.1161\/STROKEAHA.110.581991","article-title":"Occurence and clinical predictors of spasticity after ischemic stroke","volume":"41","author":"Urban","year":"2010","journal-title":"Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1191\/0269215502cr512oa","article-title":"Prevalence of spasticity post stroke","volume":"16","author":"Watkins","year":"2002","journal-title":"Clin. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1161\/01.STR.0000105386.05173.5E","article-title":"Spasticity after stroke: Its occurrence and association with motor impairments and activity limitations","volume":"35","author":"Sommerfeld","year":"2004","journal-title":"Stroke"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1080\/10749357.2018.1481605","article-title":"Improved quality of life following constraint-induced movement therapy is associated with gains in arm use, but not motor improvement","volume":"25","author":"Kelly","year":"2018","journal-title":"Top. Stroke Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1468-1331.2010.03125.x","article-title":"International consensus statement for the use of botulinum toxin treatment in adults and children with neurological impairments\u2013introduction","volume":"17","author":"Esquenazi","year":"2010","journal-title":"Eur. J. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1590\/S0004-282X2005000100006","article-title":"Botulinum toxin type A for the treatment of the upper limb spasticity after stroke: A meta-analysis","volume":"63","author":"Cardoso","year":"2005","journal-title":"Arq. Neuro-Psiquiatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.rehab.2018.05.1320","article-title":"Does botulinum toxin treatment improve upper limb active function?","volume":"62","author":"Levy","year":"2019","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.pmr.2015.07.003","article-title":"Spasticity Management After Stroke","volume":"26","author":"Bethoux","year":"2015","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1111\/j.1468-1331.2010.03129.x","article-title":"Botulinum toxin assessment, intervention and after-care for upper limb hypertonicity in adults: International consensus statement","volume":"17","author":"Sheean","year":"2010","journal-title":"Eur. J. Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e98","DOI":"10.1161\/STR.0000000000000098","article-title":"Guidelines for adult stroke rehabilitation and recovery: A guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"47","author":"Winstein","year":"2016","journal-title":"Stroke"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"13","DOI":"10.2340\/1650197771331","article-title":"The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance","volume":"7","author":"Leyman","year":"1975","journal-title":"Scand. J. Rehabil. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.1161\/01.STR.0000126900.24964.7e","article-title":"Clinimetric properties of the motor activity log for the assessment of arm use in hemiparetic patients","volume":"35","author":"Beckerman","year":"2004","journal-title":"Stroke"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"7","DOI":"10.5014\/ajot.2013.007096","article-title":"Quantifying function: The rest of the measurement story","volume":"67","author":"Doucet","year":"2013","journal-title":"Am. J. Occup. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1177\/0194599819852604","article-title":"Understanding the minimal clinically important difference (MCID) of patient-reported outcome measures","volume":"161","author":"Sedaghat","year":"2019","journal-title":"Otolaryngol.\u2013Head Neck Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/0197-2456(89)90005-6","article-title":"Measurement of health status: Ascertaining the minimal clinically important difference","volume":"10","author":"Jaeschke","year":"1989","journal-title":"Control. Clin. Trials"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e2851","DOI":"10.1097\/MD.0000000000002851","article-title":"Comparison of effects of botulinum toxin injection between subacute and chronic stroke patients: A pilot study","volume":"95","author":"Lim","year":"2016","journal-title":"Medicine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"751","DOI":"10.2522\/ptj.20060135","article-title":"Sensorimotor impairments and reaching performance in subjects with poststroke hemiparesis during the first few months of recovery","volume":"87","author":"Wagner","year":"2007","journal-title":"Phys. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1682\/JRRD.2009.09.0155","article-title":"Responsiveness and validity of three dexterous function measures in stroke rehabilitation","volume":"47","author":"Lin","year":"2010","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.jht.2008.11.004","article-title":"A narrative review of dexterity assessments","volume":"22","author":"Yancosek","year":"2009","journal-title":"J. Hand Ther."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"325","DOI":"10.5014\/ajot.2014.010546","article-title":"Predictors of motor, daily function, and quality-of-life improvements after upper-extremity robot-assisted rehabilitation in stroke","volume":"68","author":"Huang","year":"2014","journal-title":"Am. J. Occup. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/MRR.0000000000000349","article-title":"Predictors of functional and motor outcomes following upper limb robot-assisted therapy after stroke","volume":"42","author":"Leem","year":"2019","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"102534","DOI":"10.1016\/j.jelekin.2021.102534","article-title":"Robot-assisted rehabilitation of hand function after stroke: Development of prediction models for reference to therapy","volume":"57","author":"Baldan","year":"2021","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1002\/pmrj.12328","article-title":"Individualized OnabotulinumtoxinA Treatment for Upper Limb Spasticity Resulted in High Clinician- and Patient-Reported Satisfaction: Long-Term Observational Results from the ASPIRE Study","volume":"12","author":"Francisco","year":"2020","journal-title":"PM R"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1002\/mus.25721","article-title":"Effects of repeated abobotulinumtoxinA injections in upper limb spasticity","volume":"57","author":"Gracies","year":"2018","journal-title":"Muscle Nerve"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"jrm00157","DOI":"10.2340\/16501977-2801","article-title":"Longitudinal goal attainment with integrated upper limb spasticity management including repeat injections of botulinum yoxin A: Findings from the prospective, observational Upper Limb International Spasticity (ULIS-III) cohort study","volume":"53","author":"Jacinto","year":"2021","journal-title":"J. Rehabil. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"104481","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.104481","article-title":"Spasticity and Range of Motion Over Time in Stroke Patients Who Received Multiple-Dose Botulinum Toxin Therapy","volume":"29","author":"Ro","year":"2020","journal-title":"J. Stroke Cereb. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1177\/0269215515593783","article-title":"Systematic review of adjunct therapies to improve outcomes following botulinum toxin injection for treatment of limb spasticity","volume":"30","author":"Mills","year":"2016","journal-title":"Clin. Rehabil."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Hung, J.-W., Chen, Y.-W., Chen, Y.-J., Pong, Y.-P., Wu, W.-C., Chang, K.-C., and Wu, C.-Y. (2021). The Effects of Distributed vs. Condensed Schedule for Robot-Assisted Training with Botulinum Toxin A Injection for Spastic Upper Limbs in Chronic Post-Stroke Subjects. Toxins, 13.","DOI":"10.3390\/toxins13080539"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Abo, M., Shigematsu, T., Hara, H., Matsuda, Y., Nimura, A., Yamashita, Y., and Takahashi, K. (2020). Efficacy and Safety of OnabotulinumtoxinA 400 Units in Patients with Post-Stroke Upper Limb Spasticity: Final Report of a Randomized, Double-Blind, Placebo-Controlled Trial with an Open-Label Extension Phase. Toxins, 12.","DOI":"10.3390\/toxins12020127"},{"key":"ref_30","first-page":"706","article-title":"Predictive factors of upper limb motor recovery for stroke survivors admitted to a rehabilitation programme","volume":"56","author":"Wu","year":"2020","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1161\/STROKEAHA.108.530584","article-title":"Responsiveness and validity of three outcome measures of motor function after stroke rehabilitation","volume":"40","author":"Hsieh","year":"2009","journal-title":"Stroke"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1191\/0269215505cr832oa","article-title":"Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: A multicentre study","volume":"19","author":"Platz","year":"2005","journal-title":"Clin. Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"791","DOI":"10.2522\/ptj.20110009","article-title":"Clinically important differences for the upper-extremity Fugl-Meyer Scale in people with minimal to moderate impairment due to chronic stroke","volume":"92","author":"Page","year":"2012","journal-title":"Phys. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1772","DOI":"10.1056\/NEJMoa0911341","article-title":"Robot-assisted therapy for long-term upper-limb impairment after stroke","volume":"362","author":"Lo","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1212\/01.wnl.0000238164.90657.c2","article-title":"The Motor Activity Log-28: Assessing daily use of the hemiparetic arm after stroke","volume":"67","author":"Uswatte","year":"2006","journal-title":"Neurology"},{"key":"ref_36","first-page":"347","article-title":"Technique to improve chronic motor deficit after stroke","volume":"74","author":"Taub","year":"1993","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1016\/j.apmr.2008.02.022","article-title":"Estimating minimal clinically important differences of upper-extremity measures early after stroke","volume":"89","author":"Lang","year":"2008","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2369","DOI":"10.1161\/01.STR.30.11.2369","article-title":"Forced use of the upper extremity in chronic stroke patients: Results from a single-blind randomized clinical trial","volume":"30","author":"Wagenaar","year":"1999","journal-title":"Stroke"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1177\/0269215511420305","article-title":"Predictors of upper limb recovery after stroke: A systematic review and meta-analysis","volume":"26","author":"Coupar","year":"2012","journal-title":"Clin. Rehabil."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1093\/ptj\/67.2.206","article-title":"Interrater reliability of a modified Ashworth scale of muscle spasticity","volume":"67","author":"Bohannon","year":"1987","journal-title":"Phys. Ther."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1191\/026921599677595404","article-title":"A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity","volume":"13","author":"Pandyan","year":"1999","journal-title":"Clin. Rehabil."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1093\/ageing\/29.3.223","article-title":"Reliability of measurements of muscle tone and muscle power in stroke patients","volume":"29","author":"Gregson","year":"2000","journal-title":"Age Ageing"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"665","DOI":"10.2340\/16501977-0235","article-title":"Reliability and validity of the Medical Research Council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy","volume":"40","author":"Posch","year":"2008","journal-title":"J. Rehabil. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/S0031-9406(05)61454-X","article-title":"Reliability and revision of the Nottingham Sensory Assessment for stroke patients","volume":"84","author":"Lincoln","year":"1998","journal-title":"Physiotherapy"},{"key":"ref_45","unstructured":"Uswatte, G., and Taub, E. (1999). Constraint-induced movement therapy: New approaches to outcome measurement in rehabilitation. Cogn. Neurorehabilit., 215\u2013229."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1053\/apmr.2001.23183","article-title":"The reliability of the wolf motor function test for assessing upper extremity function after stroke","volume":"82","author":"Morris","year":"2001","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s12984-015-0075-8","article-title":"Kinematic measures of Arm-trunk movements during unilateral and bilateral reaching predict clinically important change in perceived arm use in daily activities after intensive stroke rehabilitation","volume":"12","author":"Chen","year":"2015","journal-title":"J. Neuroeng. Rehabil."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/14\/1\/13\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:52:20Z","timestamp":1760169140000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/14\/1\/13"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,23]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["toxins14010013"],"URL":"https:\/\/doi.org\/10.3390\/toxins14010013","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,23]]}}}