title: Goal attainment following upper-limb botulinum toxin-A injections: are we facilitating achievement of client-centred goals?
abstract: OBJECTIVE
  Evaluate upper-limb goal attainment following botulinum toxin-A, map goals to the International Classification of Functioning, Disability and Health (ICF) and explore associations between client goals, clinical indicators of spasticity and the Botulinum Toxin-A injection strategy adopted by the treating physician.
  
  
  METHODS
  Pre-test/post-test.
  
  
  METHODS
  Twenty-eight community-dwelling adults with acquired brain injury.
  
  
  METHODS
  Goal attainment was measured using the Goal Attainment Scale (GAS) 4 weeks post-injection. Goals were linked to the ICF. Clinical measures including the Modified Ashworth Scale (MAS), Tardieu Spasticity Angle (TSA) and Action Research Arm Test (ARAT) were collected pre-injection for determining association with injection strategy.
  
  
  RESULTS
  Goals represented the ICF domains of Body Structure/Function and Activity/Participation. Approximately half the goals were achieved 4 weeks post-injection and GAS T-scores improved significantly. Activity/Participation goals were equally likely to be achieved as Body Structure/Function goals. Pre-injection ARAT scores were correlated with GAS change, whereas MAS and TSA scores were not. TSA was a stronger indicator of muscle selection for botulinum toxin-A injections than MAS. Goals were directly associated with botulinum toxin-A injections for distal hand function, but not for proximal upper-limb function.
  
  
  CONCLUSIONS
  Goal setting and review provides a clinically useful process for measuring upper-limb botulinum toxin-A outcomes.
authors: School of Community Health, Charles Sturt University, Albury, Australia. mnott@csu.edu.au.
authors: Melissa T
authors: MT
authors: Nott
authors: Hannah L H
authors: HL
authors: Barden
authors: Ian J
authors: IJ
authors: Baguley
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D004185:Disability Evaluation; D005260:Female; D006040:Goals; D006801:Humans; D007267:Injections; D008297:Male; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A