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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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Proportion of patients who achieved their primary goal with BoNT-A therapy based on intensity of therapeutic input (TI). (* p < 0.05; Error bars correspond to lower and upper confidence limits of 95% CI. ROM, range of movement; CI, confidence interval).
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toxins-07-01192-f005: Proportion of patients who achieved their primary goal with BoNT-A therapy based on intensity of therapeutic input (TI). (* p < 0.05; Error bars correspond to lower and upper confidence limits of 95% CI. ROM, range of movement; CI, confidence interval).

Mentions: Of the 451 patients evaluated in this sub-analysis (data unknown for n = 5), 238 (52.8%) patients received higher intensity TI (>10 sessions) and 213 (47.2%) received lower intensity TI (≤10 sessions) between BoNT-A treatment and goal evaluation at follow-up. Patients receiving higher intensity TI had a shorter time since onset of stroke (difference in median number of months: 11.4 (95% CI: 5.4, 18.1); p < 0.001). The overall rate of primary goal achievement was significantly greater in the higher intensity TI group (83.6% (199/238); 95% CI: 78.3%, 88.1%) than in the lower intensity TI group (74.6% (159/213); 95% CI: 68.3%, 80.3%; p < 0.05). The proportion of patients achieving their primary goals in both groups across the different goal categories are shown in Figure 5.


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)

Proportion of patients who achieved their primary goal with BoNT-A therapy based on intensity of therapeutic input (TI). (* p < 0.05; Error bars correspond to lower and upper confidence limits of 95% CI. ROM, range of movement; CI, confidence interval).
© Copyright Policy
Related In: Results  -  Collection

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

toxins-07-01192-f005: Proportion of patients who achieved their primary goal with BoNT-A therapy based on intensity of therapeutic input (TI). (* p < 0.05; Error bars correspond to lower and upper confidence limits of 95% CI. ROM, range of movement; CI, confidence interval).
Mentions: Of the 451 patients evaluated in this sub-analysis (data unknown for n = 5), 238 (52.8%) patients received higher intensity TI (>10 sessions) and 213 (47.2%) received lower intensity TI (≤10 sessions) between BoNT-A treatment and goal evaluation at follow-up. Patients receiving higher intensity TI had a shorter time since onset of stroke (difference in median number of months: 11.4 (95% CI: 5.4, 18.1); p < 0.001). The overall rate of primary goal achievement was significantly greater in the higher intensity TI group (83.6% (199/238); 95% CI: 78.3%, 88.1%) than in the lower intensity TI group (74.6% (159/213); 95% CI: 68.3%, 80.3%; p < 0.05). The proportion of patients achieving their primary goals in both groups across the different goal categories are shown in Figure 5.

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