Frequency and characteristics of goal attainment following BoNT-A injection for management of spasticity

Abstract

Purpose: To determine which Goal Attainment Scale (GAS) goals are commonly achieved in patients with upper limb and/or lower limb spasticity following Botulinum Neurotoxin Type A (BoNT-A) injection.

Method: Adults who attended a Spasticity Management Clinic for upper and/or lower limb BoNT-A injection were included in this prospective cohort study. Goals were set by participants and/or carers in conjunction with the therapist using the GAS, prior to injection and reviewed at one month following the injection. Three out of the five categories of goals were passive. Goals were categorised into: mobility/transfers, pain/comfort, upper limb use, hygiene, and cosmesis. The number of responders for the GAS total score, and in each of the GAS categories, was calculated.

Results: Sixty-seven participants were recruited (mean age 51 ± 16 years; range 18–85), 70% had a stroke. Responders for mobility and transfer goals were further post injury or disease onset than non-responders (median 5.9 vs. 1.2 years, p = 0.03). Clients with stroke were less likely than other participants to achieve mobility and transfer goals (p = 0.02). There was a trend for those who achieved mobility and transfer goals to be younger (mean 49 years vs. 55 years, p = 0.06). Although active goals are more commonly identified, passive goals were more likely to be achieved.

Conclusions: Although active goals are commonly identified by people with spasticity, passive goals were more likely to be achieved following BoNT-A injection. A long duration of spasticity does not preclude patients from achieving mobility and transfer goals. Non-stroke participants were more likely to achieve mobility and transfer goals.

Implications for Rehabilitation

• Patients with chronic spasticity should be considered for BoNT-A as clinically meaningful outcomes can be achieved.

• When spasticity is present in multiple muscles, the GAS can be an assistive tool to guide clinicians in determining which muscles are a priority for injection, because the client will be more motivated to improve those specific goals.

• Although carers and patients are more willing to set active goals, these are more difficult to achieve possibly because follow up intervention or independent practise is required.

Keywords:

• Botulinum neurotoxin type A
• Goal Attainment Scale
• spasticity

Acknowledgements

The authors would like to thank Associate Professor Natasha Lannin for her very helpful comments and advice on this manuscript.

Declaration of interest

This work was supported by the Caulfield Hospital 2010/2011 Small Research Grant. The authors report no conflicts of interest.