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Toxins 2015, 7(4), 1192-1205; doi:10.3390/toxins7041192

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

1
Department of Neurorehabilitation, Gailtal-Klinik, Hermagor 9620, Austria
2
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
3
Regional Rehabilitation Unit, Northwick Park Hospital, London HA1 3UJ, UK
4
Adult Rehabilitation Department 3, Alcoitão Medical Rehabilitation Centre, Estoril 2649 506, Portugal
5
Medical Affairs, Ipsen Pharma, Boulogne-Billancourt 92650, France
*
Author to whom correspondence should be addressed.
Academic Editor: Bahman Jabbari
Received: 15 December 2014 / Revised: 16 March 2015 / Accepted: 26 March 2015 / Published: 8 April 2015
(This article belongs to the Section Bacterial Toxins)
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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. View Full-Text
Keywords: stroke; upper limb spasticity; botulinum toxin-A; goal attainment scaling (GAS) stroke; upper limb spasticity; botulinum toxin-A; goal attainment scaling (GAS)
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Fheodoroff, K.; Ashford, S.; Jacinto, J.; Maisonobe, P.; Balcaitiene, J.; Turner-Stokes, L. 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. Toxins 2015, 7, 1192-1205.

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