Goal attainment scaling in the evaluation of treatment of upper limb spasticity with botulinum toxin: a secondary analysis from a double-blind placebo-controlled randomized clinical trial.
OBJECTIVE
To examine goal attainment scaling for evaluation of treatment for upper limb post-stroke spasticity with botulinum toxin-A.


METHODS
Secondary analysis of a multi-centre double-blind, placebo-controlled randomized clinical trial.


METHODS
Six outpatient clinics in Australia.


METHODS
Patients (n=90) completing per protocol 2 cycles of treatment/placebo. Mean age 54.5 (standard deviation 13.2) years. Mean time since stroke 5.9 (standard deviation 10.5) years.


METHODS
Intramuscular botulinum toxin-A (Dysport 500-1000U) or placebo given at 0 and 12 weeks. Measurement points were baseline, 8 and 20 weeks.


METHODS
Individualized goal attainment and its relationship with spasticity and other person-centred measures - pain, mood, quality of life and global benefit.


RESULTS
A significant treatment effect was observed with respect to goal attainment (Mann-Whitney z=-2.33, p< or = 0.02). Goal-attainment scaling outcome T-scores were highly correlated with reduction in spasticity (rho=0.36, p=0.001) and global benefit (rho=0.45, p<0.001), but not with other outcome measures. Goal-attainment scaling T-scores were lower than expected (median 32.4, interquartile range 29.6-40.6). Goals related to passive tasks were more often achieved than those reflecting active function. Qualitative analysis of goals nevertheless demonstrated change over a wide area of patient experience.


CONCLUSIONS
Goal-attainment scaling provided a responsive measure for evaluating focal intervention for upper limb spasticity, identifying outcomes of importance to the individual/carers, not otherwise identifiable using standardized measures.
Turner-Stokes
Lynne
L
King's College London School of Medicine, London, Middlesex, HA1 3UJ, United Kingdom. lynne.turner-stokes@dial.pipex.com
Baguley
Ian J
IJ
De Graaff
Stephen
S
Katrak
Pesi
P
Davies
Leo
L
McCrory
Paul
P
Hughes
Andrew
A
D000203:Activities of Daily Living; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D006040:Goals; D006429:Hemiplegia / Q000534:rehabilitation; D006801:Humans; D007273:Injections, Intramuscular; D009043:Motor Activity / Q000502:physiology; D009068:Movement / Q000502:physiology; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000523:psychology / Q000534:rehabilitation; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A