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.
Highlights
Upper limb spasticity (ULS) is a common condition following stroke, which can be both painful and disabling [1]
Of the 456 patients included in the efficacy population, 132 (28.9%) had a primary goal related to passive function and 324 patients had a primary goal in other areas
As reported in the primary Upper Limb International Spasticity (ULIS)-II study, the rate of patient goal achievement following botulinum toxin-A (BoNT-A) therapy varied according to the type of primary goal, but was high (>70%) across all categories investigated [15]
Summary
Upper limb spasticity (ULS) is a common condition following stroke, which can be both painful and disabling [1]. Botulinum toxin A (BoNT-A) is established as a well-tolerated and effective treatment for reducing post-stroke spasticity [1,2,3]. Many clinical trials of BoNT-A have demonstrated improvements in muscle tone, but change at the functional level has been harder to demonstrate [1,2,4,5,6]. This is partly due the wide diversity in patient presentation and goals for treatment, as well as the failure of commonly used standardised measures to capture that diversity.
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