title: Factors influencing goal attainment in patients with post-stroke upper limb spasticity following treatment with botulinum toxin A in real-life clinical practice: sub-analyses from the Upper Limb International Spasticity (ULIS)-II Study.
abstract: In this post-hoc analysis of the ULIS-II study, we investigated factors influencing person-centred goal setting and achievement following botulinum toxin-A (BoNT-A) treatment in 456 adults with post-stroke upper limb spasticity (ULS). Patients with primary goals categorised as passive function had greater motor impairment (p < 0.001), contractures (soft tissue shortening [STS]) (p = 0.006) and spasticity (p = 0.02) than those setting other goal types. Patients with goals categorised as active function had less motor impairment (0.0001), contracture (p < 0.0001), spasticity (p < 0.001) and shorter time since stroke (p = 0.001). Patients setting goals for pain were older (p = 0.01) with more contractures (p = 0.008). The proportion of patients achieving their primary goal was not impacted by timing of first-ever BoNT-A injection (medium-term (≤1 year) vs. longer-term (>1 year)) post-stroke (80.0% vs. 79.2%) or presence or absence of severe contractures (76.7% vs. 80.6%), although goal types differed. Earlier BoNT-A intervention was associated with greater achievement of active function goals. Severe contractures impacted negatively on goal achievement except in pain and passive function. Goal setting by patients with ULS is influenced by impairment severity, age and time since stroke. Our findings resonate with clinical experience and may assist patients and clinicians in selecting realistic, achievable goals for treatment.
authors: Department of Neurorehabilitation, Gailtal-Klinik, Hermagor 9620, Austria. klemens.fheodoroff@kabeg.at.
authors: Klemens
authors: K
authors: Fheodoroff
authors: Faculty of Life Sciences and Medicine Faculty of Life Sciences and Medicine, Department of Palliative Care, Policy and Rehabilitation, King's College London, London SE5 9PJ, UK. Stephen.ashford@kcl.ac.uk.|Regional Rehabilitation Unit, Northwick Park Hospital, London HA1 3UJ, UK. Stephen.ashford@kcl.ac.uk.
authors: Stephen
authors: S
authors: Ashford
authors: Adult Rehabilitation Department 3, Alcoitão Medical Rehabilitation Centre, Estoril 2649 506, Portugal. jor.jacinto@netcabo.pt.
authors: Jorge
authors: J
authors: Jacinto
authors: Medical Affairs, Ipsen Pharma, Boulogne-Billancourt 92650, France. pascal.maisonobe@ipsen.com.
authors: Pascal
authors: P
authors: Maisonobe
authors: Medical Affairs, Ipsen Pharma, Boulogne-Billancourt 92650, France. jovita.balcaitiene@ipsen.com.
authors: Jovita
authors: J
authors: Balcaitiene
authors: Faculty of Life Sciences and Medicine Faculty of Life Sciences and Medicine, Department of Palliative Care, Policy and Rehabilitation, King's College London, London SE5 9PJ, UK. Lynne.turner-stokes@dial.pipex.com.|Regional Rehabilitation Unit, Northwick Park Hospital, London HA1 3UJ, UK. Lynne.turner-stokes@dial.pipex.com.
authors: Lynne
authors: L
authors: Turner-Stokes
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D000068079:Motor Disorders / Q000188:drug therapy / Q000453:epidemiology; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000453:epidemiology; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000453:epidemiology; D034941:Upper Extremity
chemical_list: D019274:Botulinum Toxins, Type A