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Botulinum toxin A d...
Botulinum toxin A does not improve cast treatment for idiopathic toe-walking - a randomized controlled trial
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- Engström, Pähr (författare)
- Karolinska Institutet, Dept. of Women's and Children's Health
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- Bartonek, Åsa (författare)
- Motoriklab, Department of Women’s and Children’s Health, Q:07 ALB, Karolinska University Hospital, 171 76 Stockholm, Sweden
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- Tedroff, Kristina (författare)
- Karolinska Institutet, Dept. of Women's and Children's Health
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- Orefelt, Christina (författare)
- Sollevi, Kungsgatan 2, 114 25 Stockholm, Sweden
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- Haglund-Åkerlind, Yvonne (författare)
- Aleris specialistvård Sabbatsberg, Olivecronas väg 1, 113 24 Stockholm, Sweden
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- Gutierrez-Farewik, Elena, 1973- (författare)
- KTH,Mekanik,Department of Women’s and Children’s Health. Karolinska University Hospital, Sweden,Anders Eriksson
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Karolinska Institutet, Dept of Women's and Children's Health Motoriklab, Department of Women’s and Children’s Health, Q:07 ALB, Karolinska University Hospital, 171 76 Stockholm, Sweden (creator_code:org_t)
- 2013
- 2013
- Engelska.
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Ingår i: Journal of Bone and Joint Surgery. American volume. - 0021-9355 .- 1535-1386. ; 95:5, s. 400-407
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.2...
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Abstract
Ämnesord
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- Background: There are many treatments for idiopathic toe-walking, including casts with or without injection of botulinum toxin A. Combined treatment with casts and botulinum toxin A has become more common even though there have been few studies of its efficacy and safety problems. Our aims were to conduct a randomized controlled trial to test the hypotheses that combined treatment with casts and botulinum toxin A is more effective than casts alone in reducing toewalking by patients five to fifteen years of age, and that the treatment effect correlates with the extent of coexisting neuropsychiatric problems. Methods: All patients who had been consecutively admitted to the pediatric orthopaedics department of our institution because of idiopathic toe-walking between November 2005 and April 2010 were considered for inclusion in the study. Forty-seven children constituted the study population. The children were randomized to undergo four weeks of treatment with below-the-knee casts either as the sole intervention or to undergo the cast treatment one to two weeks after receiving injections of botulinum toxin A into the calves. Before treatment and three and twelve months after cast removal, all children underwent three-dimensional (3-D) gait analysis. The severity of the idiopathic toe-walking was classified on the basis of the gait analysis, and the parents rated the time that their child spent on his/her toes during barefoot walking. Passive hip, knee, and ankle motion as well as ankle dorsiflexor strength were measured. Before treatment, all children were evaluated with a screening questionnaire for neuropsychiatric problems. Results: No differences were found in any outcome parameter between the groups before treatment or at three or twelve months after cast removal. Several gait-analysis parameters, passive ankle motion, and ankle dorsiflexor strength were improved at both three and twelve months in both groups, even though many children still demonstrated some degree of toe-walking. The treatment outcomes were not correlated with coexisting neuropsychiatric problems. Conclusion: Adding botulinum toxin-A injections prior to cast treatment for idiopathic toe-walking does not improve the outcome of cast-only treatment. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Ortopedi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Orthopaedics (hsv//eng)
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