Botulinum toxin for lower limb function after stroke : a scoping review mapped to the International Classification of Health, Disability and Function (ICF)

Abstract

This study followed a scoping review approach aimed to map and synthesise the available evidence on the effects of botulinum toxin on lower limb function following stroke, with outcomes categorised according to the ICF framework. A scoping review was conducted in accordance with Joanna Briggs Institute methodology and reported using PRISMA-ScR guidelines. Electronic databases (PubMed and Scopus) and grey literature sources were searched for studies published between 2015 and 2025. Studies were included if they involved adult stroke populations receiving botulinum toxin interventions targeting lower limb muscles and reported functional outcomes. Data were extracted and synthesised descriptively, with outcomes mapped to the ICF domains of body functions and structures, activity, and participation.<br>Twenty-nine studies were included, comprising predominantly experimental designs, particularly randomised controlled trials. Botulinum toxin was most commonly administered to the gastrocnemius and soleus muscles and was rarely used in isolation, typically combined with physiotherapy and other rehabilitation strategies. Outcomes were predominantly reported at the impairment level, with muscle tone (measured using the Modified Ashworth Scale) being the most frequently assessed outcome. Activity-level outcomes, including gait speed and functional mobility, were commonly evaluated but demonstrated variable findings. Participation-level outcomes were markedly underrepresented, with only a small number of studies assessing activities of daily living, quality of life, or broader functional impact.<br>