Barriers to Long-Term Adherence in Botulinum Toxin Therapy for Post-Stroke Spasticity: Insights and Implications from a Single-Center Study in North Italy
Stroke is a leading cause of long-term disability worldwide, often resulting in spasticity. Botulinum toxin injections have emerged as a cornerstone in the management of post-stroke spasticity. However, despite their clinical efficacy, maintaining long-term adherence to botulinum toxin therapy remai...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-02-01
|
| Series: | Toxins |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2072-6651/17/3/102 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849340641160462336 |
|---|---|
| author | Ester Cecchella Nicola Luigi Bragazzi Filippo Cotellessa William Campanella Luca Puce Lucio Marinelli Antonio Currà Cristina Schenone Laura Mori Carlo Trompetto |
| author_facet | Ester Cecchella Nicola Luigi Bragazzi Filippo Cotellessa William Campanella Luca Puce Lucio Marinelli Antonio Currà Cristina Schenone Laura Mori Carlo Trompetto |
| author_sort | Ester Cecchella |
| collection | DOAJ |
| description | Stroke is a leading cause of long-term disability worldwide, often resulting in spasticity. Botulinum toxin injections have emerged as a cornerstone in the management of post-stroke spasticity. However, despite their clinical efficacy, maintaining long-term adherence to botulinum toxin therapy remains a significant challenge. This retrospective observational study analyzed 106 patients undergoing botulinum toxin therapy for post-stroke spasticity to identify the key factors influencing treatment continuation. The mean age of the cohort at the time of stroke was 57.7 years, with ischemic strokes accounting for 61.3% of cases and hemorrhagic strokes for 38.7%. A total of 61.3% of patients continued therapy, while 38.7% discontinued therapy due to a variety of reasons. The most common reasons included logistical barriers (43.9%) and comorbidities (36.6%), followed by perceived lack of benefit (24.4%) and clinical resolution (12.2%). Among those citing a lack of benefit, muscular fibrosis was a notable contributor. In the multivariable Cox regression analysis, logistical challenges, such as access to healthcare facilities and administrative difficulties, were associated with discontinuation (HR = 13.95, 95% CI: 5.57–34.94, <i>p</i> < 0.001). Comorbidities also significantly increased the likelihood of discontinuation (HR = 3.51, 95% CI: 1.56–7.87, <i>p</i> = 0.002), as did the lack of benefit (HR = 14.34, 95% CI: 5.65–36.38, <i>p</i> < 0.001) and condition resolution (HR = 19.20, 95% CI: 5.58–66.02, <i>p</i> < 0.001). In contrast, demographic and clinical factors, including age at the time of stroke, gender, stroke type, affected side, and baseline spasticity severity, did not significantly influence treatment continuation. These findings underscore the importance of addressing logistical barriers and mitigating the burden of comorbidities to enhance treatment adherence. A shift toward patient-centered approaches that integrate robust rehabilitation services and streamline healthcare accessibility is critical for optimizing outcomes. |
| format | Article |
| id | doaj-art-f0ce5a69ece441f5b82b3149f0bb8f80 |
| institution | Kabale University |
| issn | 2072-6651 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Toxins |
| spelling | doaj-art-f0ce5a69ece441f5b82b3149f0bb8f802025-08-20T03:43:51ZengMDPI AGToxins2072-66512025-02-0117310210.3390/toxins17030102Barriers to Long-Term Adherence in Botulinum Toxin Therapy for Post-Stroke Spasticity: Insights and Implications from a Single-Center Study in North ItalyEster Cecchella0Nicola Luigi Bragazzi1Filippo Cotellessa2William Campanella3Luca Puce4Lucio Marinelli5Antonio Currà6Cristina Schenone7Laura Mori8Carlo Trompetto9IRCCS Ospedale Policlinico San Martino, 16132 Genoa, ItalyDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, ItalyDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, ItalyIRCCS Ospedale Policlinico San Martino, 16132 Genoa, ItalyDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, ItalyIRCCS Ospedale Policlinico San Martino, 16132 Genoa, ItalyAcademic Neurology Unit, A. Fiorini Hospital, 04019 Terracina, ItalyDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, ItalyIRCCS Ospedale Policlinico San Martino, 16132 Genoa, ItalyIRCCS Ospedale Policlinico San Martino, 16132 Genoa, ItalyStroke is a leading cause of long-term disability worldwide, often resulting in spasticity. Botulinum toxin injections have emerged as a cornerstone in the management of post-stroke spasticity. However, despite their clinical efficacy, maintaining long-term adherence to botulinum toxin therapy remains a significant challenge. This retrospective observational study analyzed 106 patients undergoing botulinum toxin therapy for post-stroke spasticity to identify the key factors influencing treatment continuation. The mean age of the cohort at the time of stroke was 57.7 years, with ischemic strokes accounting for 61.3% of cases and hemorrhagic strokes for 38.7%. A total of 61.3% of patients continued therapy, while 38.7% discontinued therapy due to a variety of reasons. The most common reasons included logistical barriers (43.9%) and comorbidities (36.6%), followed by perceived lack of benefit (24.4%) and clinical resolution (12.2%). Among those citing a lack of benefit, muscular fibrosis was a notable contributor. In the multivariable Cox regression analysis, logistical challenges, such as access to healthcare facilities and administrative difficulties, were associated with discontinuation (HR = 13.95, 95% CI: 5.57–34.94, <i>p</i> < 0.001). Comorbidities also significantly increased the likelihood of discontinuation (HR = 3.51, 95% CI: 1.56–7.87, <i>p</i> = 0.002), as did the lack of benefit (HR = 14.34, 95% CI: 5.65–36.38, <i>p</i> < 0.001) and condition resolution (HR = 19.20, 95% CI: 5.58–66.02, <i>p</i> < 0.001). In contrast, demographic and clinical factors, including age at the time of stroke, gender, stroke type, affected side, and baseline spasticity severity, did not significantly influence treatment continuation. These findings underscore the importance of addressing logistical barriers and mitigating the burden of comorbidities to enhance treatment adherence. A shift toward patient-centered approaches that integrate robust rehabilitation services and streamline healthcare accessibility is critical for optimizing outcomes.https://www.mdpi.com/2072-6651/17/3/102strokespasticitybotulinum toxintreatment discontinuationsurvival analysisKaplan–Meier analysis |
| spellingShingle | Ester Cecchella Nicola Luigi Bragazzi Filippo Cotellessa William Campanella Luca Puce Lucio Marinelli Antonio Currà Cristina Schenone Laura Mori Carlo Trompetto Barriers to Long-Term Adherence in Botulinum Toxin Therapy for Post-Stroke Spasticity: Insights and Implications from a Single-Center Study in North Italy Toxins stroke spasticity botulinum toxin treatment discontinuation survival analysis Kaplan–Meier analysis |
| title | Barriers to Long-Term Adherence in Botulinum Toxin Therapy for Post-Stroke Spasticity: Insights and Implications from a Single-Center Study in North Italy |
| title_full | Barriers to Long-Term Adherence in Botulinum Toxin Therapy for Post-Stroke Spasticity: Insights and Implications from a Single-Center Study in North Italy |
| title_fullStr | Barriers to Long-Term Adherence in Botulinum Toxin Therapy for Post-Stroke Spasticity: Insights and Implications from a Single-Center Study in North Italy |
| title_full_unstemmed | Barriers to Long-Term Adherence in Botulinum Toxin Therapy for Post-Stroke Spasticity: Insights and Implications from a Single-Center Study in North Italy |
| title_short | Barriers to Long-Term Adherence in Botulinum Toxin Therapy for Post-Stroke Spasticity: Insights and Implications from a Single-Center Study in North Italy |
| title_sort | barriers to long term adherence in botulinum toxin therapy for post stroke spasticity insights and implications from a single center study in north italy |
| topic | stroke spasticity botulinum toxin treatment discontinuation survival analysis Kaplan–Meier analysis |
| url | https://www.mdpi.com/2072-6651/17/3/102 |
| work_keys_str_mv | AT estercecchella barrierstolongtermadherenceinbotulinumtoxintherapyforpoststrokespasticityinsightsandimplicationsfromasinglecenterstudyinnorthitaly AT nicolaluigibragazzi barrierstolongtermadherenceinbotulinumtoxintherapyforpoststrokespasticityinsightsandimplicationsfromasinglecenterstudyinnorthitaly AT filippocotellessa barrierstolongtermadherenceinbotulinumtoxintherapyforpoststrokespasticityinsightsandimplicationsfromasinglecenterstudyinnorthitaly AT williamcampanella barrierstolongtermadherenceinbotulinumtoxintherapyforpoststrokespasticityinsightsandimplicationsfromasinglecenterstudyinnorthitaly AT lucapuce barrierstolongtermadherenceinbotulinumtoxintherapyforpoststrokespasticityinsightsandimplicationsfromasinglecenterstudyinnorthitaly AT luciomarinelli barrierstolongtermadherenceinbotulinumtoxintherapyforpoststrokespasticityinsightsandimplicationsfromasinglecenterstudyinnorthitaly AT antoniocurra barrierstolongtermadherenceinbotulinumtoxintherapyforpoststrokespasticityinsightsandimplicationsfromasinglecenterstudyinnorthitaly AT cristinaschenone barrierstolongtermadherenceinbotulinumtoxintherapyforpoststrokespasticityinsightsandimplicationsfromasinglecenterstudyinnorthitaly AT lauramori barrierstolongtermadherenceinbotulinumtoxintherapyforpoststrokespasticityinsightsandimplicationsfromasinglecenterstudyinnorthitaly AT carlotrompetto barrierstolongtermadherenceinbotulinumtoxintherapyforpoststrokespasticityinsightsandimplicationsfromasinglecenterstudyinnorthitaly |