[Show abstract][Hide abstract] ABSTRACT: To evaluate the effectiveness of ultrasound-guided phenol nerve block in the treatment of severe hip adductor spasticity in long-term care patients.Methods
Double-blind placebo-controlled trial with a 9-month follow-up period.SettingA 250-bed long-term care hospital and the infirmary units of 5 regional hospitals.ParticipantsTwenty-six long-term care patients with bilateral severe chronic hip adductor spasticity affecting perineal hygiene and nursing care.InterventionsPatients were randomized to 2 groups that received ultrasound and electrical stimulator guided obturator nerve block using either 5% phenol in aqueous solution or saline.Main Outcome MeasuresThe primary outcome measure was the Modified Ashworth Scale, which reflected the severity of hip adductor spasticity. Secondary outcomes included Goal Attainment Scale (GAS), hygiene score, distances between the knees during fast and slow passive hip abductions; passive range of movement for hip extension and knee extension. Pain was assessed using the Pain Assessment in Advanced Dementia Scale.ResultsTwenty-six patients (7 males; mean age = 77, standard deviation = 14) were recruited. At week 6 post-injection, 12/16 (75%) patients in the treatment group vs 1/10 (10%) patients in the control group had at least 1-point reduction of Modified Ashworth Scale (P = .001) on both hip adductors. There was also significant improvement in the GAS, as well as the hygiene score, resting position, and distances between the knees during fast and slow passive hip abductions in the treatment group, which persisted until week 36. No significant difference in the Pain Assessment in Advanced Dementia Scale was found between the 2 groups. No serious phenol nerve block related adverse effects were reported.Conclusions
Obturator neurolysis with 5% aqueous phenol as guided by both ultrasound and electrical stimulation can safely and effectively reduce hip adductor spasticity, thus, improving hygiene scores and patient-centered outcomes measured by the GAS in affected long-term care residents.
No preview · Article · Nov 2014 · Journal of the American Medical Directors Association
[Show abstract][Hide abstract] ABSTRACT: To evaluate whether botulinum toxin can decrease the burden for caregivers of long term care patients with severe upper limb spasticity.
This was a double-blind placebo-controlled trial with a 24-week follow-up period.
A 250-bed long term care hospital, the infirmary units of 3 regional hospitals, and 5 care and attention homes.
Participants included 55 long term care patients with significant upper limb spasticity and difficulty in basic upper limb care.
Patients were randomized into 2 groups that received either intramuscular botulinum toxin A or saline.
The primary outcome measure was provided by the carer burden scale. Secondary outcomes included goal attainment scale, measure of spasticity by modified Ashworth score, passive range of movement for shoulder abduction, and elbow extension and finger extension. Pain was assessed using the Pain Assessment in Advanced Dementia Scale.
A total of 55 patients (21 men; mean age = 69, SD =18) were recruited. At week 6 post-injection, 18 (60%) of 30 patients in the treatment group versus 2 (8%) of 25 patients in the control group had a significant 4-point reduction of carer burden scale (P < .001). There was also significant improvement in the goal attainment scale, as well as the modified Ashworth score, resting angle, and passive range of movement of the 3 regions (shoulder, elbow, and fingers) in the treatment group which persisted until week 24. There were also fewer spontaneous bone fractures after botulinum toxin injection, although this did not reach statistical significance. No significant difference in Pain Assessment in Advanced Dementia scale was found between the 2 groups. No serious botulinum toxin type A-related adverse effects were reported.
Long term care patients who were treated for upper limb spasticity with intramuscular injections of botulinum toxin A had a significant decrease in the caregiver burden. The treatment was also associated with improved scores on patient-centered outcome measures.
No preview · Article · Apr 2012 · Journal of the American Medical Directors Association