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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.

Fheodoroff K, Ashford S, Jacinto J, Maisonobe P, Balcaitiene J, Turner-Stokes L - Toxins (Basel) (2015)

Bottom Line: 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.Our findings resonate with clinical experience and may assist patients and clinicians in selecting realistic, achievable goals for treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurorehabilitation, Gailtal-Klinik, Hermagor 9620, Austria. klemens.fheodoroff@kabeg.at.

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.

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Related in: MedlinePlus

Task-based activities achieved for patients whose primary goals for treatment related to passive function. Unspecified goals related to “Improvement in ease of care” and “Less care burden”.
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toxins-07-01192-f001: Task-based activities achieved for patients whose primary goals for treatment related to passive function. Unspecified goals related to “Improvement in ease of care” and “Less care burden”.

Mentions: Rates of goal achievement were significantly greater for primary passive function goals (n = 113/132; 85.6%) than for other primary goals (n = 250/324; 77.2%; p = 0.04). Table S1 (Supplementary Information) provides a further breakdown of the types of passive function targeted. Among the specified goals, 63 (47.7%) were focused on the distal portion of the limb (i.e., the hand/wrist), and nine (6.8%) were focused on the proximal portion (elbow/shoulder); the remaining 60 (45.5%) were focused on the whole arm or were otherwise unspecified, reflecting the wide range of muscles used in this cohort [15]. The achievement of five different types of task-based activities—dressing the affected limb; maintaining hygiene in the palm, axilla and elbow crease; nail cutting; splint application; therapy and/or positioning—is shown in Figure 1.


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.

Fheodoroff K, Ashford S, Jacinto J, Maisonobe P, Balcaitiene J, Turner-Stokes L - Toxins (Basel) (2015)

Task-based activities achieved for patients whose primary goals for treatment related to passive function. Unspecified goals related to “Improvement in ease of care” and “Less care burden”.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4417963&req=5

toxins-07-01192-f001: Task-based activities achieved for patients whose primary goals for treatment related to passive function. Unspecified goals related to “Improvement in ease of care” and “Less care burden”.
Mentions: Rates of goal achievement were significantly greater for primary passive function goals (n = 113/132; 85.6%) than for other primary goals (n = 250/324; 77.2%; p = 0.04). Table S1 (Supplementary Information) provides a further breakdown of the types of passive function targeted. Among the specified goals, 63 (47.7%) were focused on the distal portion of the limb (i.e., the hand/wrist), and nine (6.8%) were focused on the proximal portion (elbow/shoulder); the remaining 60 (45.5%) were focused on the whole arm or were otherwise unspecified, reflecting the wide range of muscles used in this cohort [15]. The achievement of five different types of task-based activities—dressing the affected limb; maintaining hygiene in the palm, axilla and elbow crease; nail cutting; splint application; therapy and/or positioning—is shown in Figure 1.

Bottom Line: 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.Our findings resonate with clinical experience and may assist patients and clinicians in selecting realistic, achievable goals for treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurorehabilitation, Gailtal-Klinik, Hermagor 9620, Austria. klemens.fheodoroff@kabeg.at.

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.

Show MeSH
Related in: MedlinePlus