Goal attainment scaling in the evaluation of treatment of upper limb spasticity with botulinum toxin: A secondary analysis from a double-blind placebo-controlled randomized clinical trial

Turner-Stokes, Lynne; Baguley, Ian; Graaff, Stephen de; Katrak, Pesi; Davies, Leo; McCrory, Paul; Hughes, A.J.

doi:10.2340/16501977-0474

Cited by 121 publications

(114 citation statements)

References 27 publications

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“…Thus, our findings make a threefold contribution to the literature: (1) We confirm previous findings that the majority of the goals set by patients with upper limb spasticity are in the activity and participation category, 14,15 (2) we show that the majority of the goals set by patients with stroke and ABI who have lower limb spasticity are in the activity and participation category (see Table 3), and (3) our results extend previous findings with patients with stroke 14,15 to the population of patients with spasticity from other causes, such as spinal cord injury, MS, and CP. Individuals set activity goals to improve their physical function, which is an important domain in HRQOL.…”

Section: Discussion Activity and Participation Goals Versus Body Funcsupporting

confidence: 87%

“…A previous study of treatment of upper limb spasticity reported that 11 patients (6%) set walking and balance goals, 14 suggesting the possible impact of upper limb spasticity on walking. Our sample included patients with lower limb spasticity, which explains the much higher occurrence (30%; see Table 2) of gait-related goals in this study.…”

Section: Analysis Of Goalsmentioning

confidence: 99%

“…The occurrence of self-care goals found in this study was similar to that found in a previous study in patients post-stroke. 14 Almost one-third (14) of the goals set in the body functions and structures category were related to reducing pain, which indicates that patients expect pain relief from BoNTA injections. This result is similar to that of a previous report showing that patients believed that spasticity was related to pain and that patients also experienced pain relief from a reduction in spasticity with BoNTA injections.…”

Section: Analysis Of Goalsmentioning

confidence: 99%

“…13 Goals based on the ICF model that are set by patients after stroke and ABI and before receiving upper limb spasticity treatment with BoNTA are typically in either the body functions and structures category (26% of goals) or the activity and participation category (74% of goals). 14,15 The ICF categories of goals set by patients with UMN disorders (other than ABI and stroke), as well as those set by patients for whom treatment with BoNTA is targeted at lower limb spasticity, are not known. The effect of pattern of spasticity on the type of goals set by patients receiving BoNTA for spasticity management is also not known.…”

mentioning

confidence: 99%

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Goals Set by Patients Using the ICF Model before Receiving Botulinum Injections and Their Relation to Spasticity Distribution

Choi

Peters

Tri

et al. 2017

Physiotherapy Canada

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Purpose: Goal Attainment Scaling (GAS) is used to assess functional gains in response to treatment. Specific characteristics of the functional goals set by individuals receiving botulinum toxin type A (BoNTA) injections for spasticity management are unknown. The primary objectives of this study were to describe the characteristics of the goals set by patients before receiving BoNTA injections using the International Classification of Functioning, Disability and Health (ICF) and to determine whether the pattern of spasticity distribution affected the goals set. Methods: A cross-sectional retrospective chart review was carried out in an outpatient spasticity-management clinic in Toronto. A total of 176 patients with a variety of neurological lesions attended the clinic to receive BoNTA injections and completed GAS from December 2012 to December 2013. The main outcome measures were the characteristics of the goals set by the participants on the basis of ICF categories (body functions and structures, activity and participation) and the spasticity distribution using Modified Ashworth Scale scores. Results: Of the patients, 73% set activity and participation goals, and 27% set body functions and structures goals (p < 0.05). In the activity and participation category, 30% of patients set moving and walking goals, 28% set self-care and dressing goals, and 12% set changing and maintaining body position goals. In the body functions and structures category, 18% set neuromuscular and movement-related goals, and 8% set pain goals. The ICF goal categories were not related to the patterns of spasticity (upper limb vs. lower limb or unilateral vs. bilateral spasticity) or type of upper motor neuron (UMN) lesion (p > 0.05). Conclusion: Our results show that patients receiving BoNTA treatment set a higher percentage of activity and participation goals than body functions and structures goals. Goal classification was not affected by type of spasticity distribution or type of UMN disorder.Key Words: activities of daily living; botulinum toxin; goals; muscle spasticity; patient participation. RÉ SUMÉObjectif : l'é chelle de ré alisation des objectifs (Goal Attainment Scaling ou GAS) est employé e pour é valuer les gains fonctionnels en ré ponse à un traitement. On ne connaît pas les caracté ristiques des objectifs fonctionnels é tablis par les personnes recevant des injections de toxine botulinique de type A (BoNTA) pour la prise en charge de la spasticité . Cette é tude vise à dé crire les caracté ristiques des objectifs é tablis par les patients avant de recevoir des injections de BoNTA à l'aide de la Classification internationale du fonctionnement, du handicap et de la santé (CIF) et à dé terminer si le modè le de distribution de la spasticité avait un effet sur les objectifs é tablis. Mé thodologie : on a mené une revue ré trospective transversale des dossiers d'une clinique ambulatoire de prise en charge de la spasticité à Toronto. Au total, 176 patients ayant diverses lé sions neurologiques sont venus à la clinique pou...

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Section: Discussion Activity and Participation Goals Versus Body Funcsupporting

confidence: 87%

Section: Analysis Of Goalsmentioning

confidence: 99%

Section: Analysis Of Goalsmentioning

confidence: 99%

mentioning

confidence: 99%

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Goals Set by Patients Using the ICF Model before Receiving Botulinum Injections and Their Relation to Spasticity Distribution

Choi

Peters

Tri

et al. 2017

Physiotherapy Canada

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“…It is increasingly used as a person-centred outcome measure in research evaluations of outcome following spasticity intervention [16][17][18][19][20] , and is recommended as a method of recording patient-reported outcomes in guidelines for management of spasticity with Botulinum toxin 21 .…”

Section: Procedurementioning

confidence: 99%

Conceptualization and Development of the Leg Activity Measure (LegA) for Patient and Carer Reported Assessment of Activity in the Paretic Leg

Ashford

Jackson

Mahaffey

et al. 2016

Physiotherapy Res Intl

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ObjectiveTo develop a patient reported outcome measure (PROM) of active and passive function in the paretic lower limb. MethodsPotential items for inclusion were identified through a) systematic review and analysis of existing measures and b) analysis of the primary goals for treatment in a spasticity service. Item reduction was achieved through consultation with a purposively-selected group of experienced physiotherapists and occupational therapists (n=16) in a 2-round Delphi process. This was followed by review of Delphi consultation findings by the Project Advisory Group (PAG) consisting of patients and carers. Results Development of the LegA included two rounds of Delphi consultation. Further roundswere not required due to the high degree (80%) of agreement between respondents in rounds one and two. From an initial shortlist of 126 items, 29 items were initially identified for inclusion in LegA, and subsequently refined to a 24-item (two sub-scales) tool consisting of 9 passive function sub-scale items and 15 active function sub-scale items. The Delphi consultation ensured content validity, due to the experience of the clinicians in this area of practice and therefore appropriate reduction of items. In common with previous work in the upper limb, a 5-point ordinal scaling structure was chosen, with ratings based on activity over the preceding 7 days. ConclusionsThe LegA is designed to measure passive and active function following focal interventions for the paretic lower limb. Content and face validity have initially been Development of the Leg Activity Measure (LegA) 3 addressed within the development process. The next phase of development will involve formal evaluation of psychometric properties. Word count 250

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Multidisciplinary care for Guillain-Barré syndrome

Khan

Amatya

et al. 2010

Cochrane Database of Systematic Reviews

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Goal attainment scaling in the evaluation of treatment of upper limb spasticity with botulinum toxin: A secondary analysis from a double-blind placebo-controlled randomized clinical trial

Abstract: Goal-attainment scaling provided a responsive measure for evaluating focal intervention for upper limb spasticity, identifying outcomes of importance to the individual/carers, not otherwise identifiable using standardized measures.

Cited by 121 publications

References 27 publications

Goals Set by Patients Using the ICF Model before Receiving Botulinum Injections and Their Relation to Spasticity Distribution

Goals Set by Patients Using the ICF Model before Receiving Botulinum Injections and Their Relation to Spasticity Distribution

Conceptualization and Development of the Leg Activity Measure (LegA) for Patient and Carer Reported Assessment of Activity in the Paretic Leg

Multidisciplinary care for Guillain-Barré syndrome

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