{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:34:47Z","timestamp":1791862487798,"version":"4.3.4"},"reference-count":13,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T00:00:00Z","timestamp":1732579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Australian National Health and Medical Research Council","award":["GNT1079542"],"award-info":[{"award-number":["GNT1079542"]}]},{"name":"Australian National Health and Medical Research Council","award":["GNT102055"],"award-info":[{"award-number":["GNT102055"]}]},{"name":"National Heart Foundation of Australia","award":["GNT1079542"],"award-info":[{"award-number":["GNT1079542"]}]},{"name":"National Heart Foundation of Australia","award":["GNT102055"],"award-info":[{"award-number":["GNT102055"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>We examined the effect of botulinum toxin-A on upper limb impairments and activity limitations in chronic stroke. This study is a secondary analysis of control group data from a national, multicenter, Phase III randomized trial with a masked outcome assessment. We studied 71 stroke survivors who received a botulinum toxin-A injection in any muscle(s) that crosses the wrist due to significant spasticity after a stroke greater than 3 months previously. We measured upper limb activity, spasticity, range of motion, grip strength, pain and other outcomes at injection and three months later. The median difference between injection and 3 months later was 0.0 blocks\/s (interquartile range (IQR) 0.0) on the Box and Block Test, 0\/4 (IQR 1) on the Tardieu Scale, 4 degrees (IQR 26) of wrist extension, 0.0 kg (IQR 2) of grip strength, 0.0 (IQR 1.5) on the 10 cm visual analogue scale for pain, 0\/100 (IQR 21) on the 10 cm visual analogue scale for overall health, 0\/3 (IQR 0) for self-care and \u22122 (IQR 8) for burden of care. In chronic stroke survivors who have little activity in their upper limb, botulinum toxin-A is not effective in improving any measured outcomes and does not appear to be clinically justified in this population with severe activity limitations.<\/jats:p>","DOI":"10.3390\/toxins16120510","type":"journal-article","created":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T04:02:18Z","timestamp":1732593738000},"page":"510","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Lack of Effect of Botulinum Toxin-A on Upper Limb Activity in Chronic Stroke: A Short Report from the InTENSE Trial"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0147-047X","authenticated-orcid":false,"given":"Ian D.","family":"Cameron","sequence":"first","affiliation":[{"name":"John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1369-5721","authenticated-orcid":false,"given":"Louise","family":"Ada","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Crotty","sequence":"additional","affiliation":[{"name":"College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia"},{"name":"Flinders Medical Centre, Bedford Park, SA 5042, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mithu","family":"Palit","sequence":"additional","affiliation":[{"name":"Alfred Health, Melbourne, VIC 3004, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia","family":"Huang","sequence":"additional","affiliation":[{"name":"Flinders Medical Centre, Bedford Park, SA 5042, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7069-1191","authenticated-orcid":false,"given":"John","family":"Olver","sequence":"additional","affiliation":[{"name":"Epworth Monash, Rehabilitation Research Unit, Richmond, VIC 3121, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven G.","family":"Faux","sequence":"additional","affiliation":[{"name":"Sacred Heart Rehabilitation, St Vincent\u2019s Hospital Sydney, Darlinghurst, NSW 2010, Australia"},{"name":"St Vincent\u2019s Clinical School, University of New South Wales, Sydney, NSW 2033, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senen","family":"Gonzales","sequence":"additional","affiliation":[{"name":"Austin Hospital, Heidelberg, VIC 3084, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Anthonisz","sequence":"additional","affiliation":[{"name":"Alfred Health, Melbourne, VIC 3004, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malcolm","family":"Bowman","sequence":"additional","affiliation":[{"name":"St Joseph\u2019s Hospital, St Vincent\u2019s HealthCare, East Sydney, NSW 2010, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2608-3495","authenticated-orcid":false,"given":"Yuriko","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Sacred Heart Rehabilitation, St Vincent\u2019s Hospital Sydney, Darlinghurst, NSW 2010, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9832-4737","authenticated-orcid":false,"given":"Yan","family":"Chow","sequence":"additional","affiliation":[{"name":"Austin Hospital, Heidelberg, VIC 3084, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Milte","sequence":"additional","affiliation":[{"name":"Caring Futures Institute, Flinders University, Bedford Park, SA 5042, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Ratcliffe","sequence":"additional","affiliation":[{"name":"Caring Futures Institute, Flinders University, Bedford Park, SA 5042, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Coralie K.","family":"English","sequence":"additional","affiliation":[{"name":"Heart and Stroke Program, School of Health Sciences, University of Newcastle, Callaghan, NSW 2308, Australia"},{"name":"Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2066-8345","authenticated-orcid":false,"given":"Natasha A.","family":"Lannin","sequence":"additional","affiliation":[{"name":"Alfred Health, Melbourne, VIC 3004, Australia"},{"name":"Department of Neurosciences, Central Clinical School, Monash University, Clayton, VIC 3800, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,26]]},"reference":[{"key":"ref_1","unstructured":"Stroke Foundation (2024, November 04). Clinical Guidelines for Stroke Management; Melbourne, Australia, 2024. Available online: https:\/\/informme.org.au\/Guidelines\/Clinical-Guidelines-for-Stroke-Management."},{"key":"ref_2","unstructured":"Royal College of Physicians, British Society of Rehabilitation Medicine, The Chartered Society of Physiotherapy, Association of Chartered Physiotherapists in Neurology and the Royal College of Occupational Therapists (2018). Spasticity in Adults: Management Using Botulinum Toxin, Royal College of Physicians. National Guidelines."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1161\/STROKEAHA.119.027602","article-title":"Effect of Additional Rehabilitation After Botulinum Toxin-A on Upper Limb Activity in Chronic Stroke: The InTENSE Trial","volume":"51","author":"Lannin","year":"2020","journal-title":"Stroke"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1016\/j.apmr.2012.12.006","article-title":"Treatment with botulinum toxin improves upper-extremity function post stroke: A systematic review and meta-analysis","volume":"94","author":"Foley","year":"2013","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1177\/1747493018765228","article-title":"Effect of adding upper limb rehabilitation to botulinum toxin-A on upper limb activity after stroke: Protocol for the InTENSE trial","volume":"13","author":"Lannin","year":"2018","journal-title":"Int. J. Stroke"},{"key":"ref_6","unstructured":"Australasian Faculty of Rehabilitation Medicine (2013). Position Statement on the Therapeutic Use of Botulinum Toxin in Rehabilitation Medicine for Spasticity and Dystonia, Australasian Faculty of Rehabilitation Medicine."},{"key":"ref_7","unstructured":"(2024, November 04). Pharmaceutical Benefits Scheme (PBS). Section 100\u2014Highly Specialised Drugs Program, Available online: http:\/\/www.pbs.gov.au\/info\/browse\/section-100\/s100-highly-specialised-drugs."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"386","DOI":"10.5014\/ajot.39.6.386","article-title":"Adult norms for the Box and Block Test of manual dexterity","volume":"39","author":"Mathiowetz","year":"1985","journal-title":"Am. J. Occup. 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Sci."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/16\/12\/510\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:39:31Z","timestamp":1760114371000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/16\/12\/510"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,26]]},"references-count":13,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["toxins16120510"],"URL":"https:\/\/doi.org\/10.3390\/toxins16120510","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,26]]}}}