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

Mullins, Denita; Winter, Adele; Fini, Natalie A; Dixon, Caroline; Aldous, Sara; Palit, Mithu; Holland, Anne E

doi:10.3109/09638288.2015.1107781

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…A single muscle is rarely treated in isolation; the spastic pattern and the spastic muscles responsible for it must be clearly understood by the evaluating clinician to ensure appropriate muscle targeting for BoNT-A injection. The GAS can be used to guide clinicians in deciding which muscles are a priority for injection and ensure the muscles selected are related to the goal, helping to keep the decision goal-focused and patient-focused [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Selecting Goals and Target Muscles for Botulinum Toxin A Injection Using the Goal Oriented Facilitated Approach to Spasticity Treatment (GO-FAST) Tool

Jacinto,

Balbert,

Bensmail

et al. 2023

Toxins

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The objective of this article is to introduce the GO-FAST Tool (developed by the Toxnet group) to clinicians working in the field of neurological rehabilitation, specifically post-stroke spasticity management. The concepts utilized in the Tool and described in this article can be broadly grouped into five topics: the principles of patient-centred goal-setting; an algorithm for setting SMART (specific, measurable, attainable, realistic, and timed) treatment goals; goal-related target muscles and botulinum toxin type A dose determinants; goal attainment follow-up, scoring, and interpretation; and the multimodal approach to spasticity management. The Tool can enhance clinical practice by providing guided assistance with goal-setting and target muscle selection for botulinum toxin type A treatment. It also provides support with the follow-up evaluation of goal attainment and calculation of treatment success. The Tool is designed to be used by clinicians with varying levels of expertise in the field of neurological rehabilitation and post-stroke spasticity management, from those who are new to the field to those with many years of experience. A case study is presented in the Results Section of the article to illustrate the utility of the Tool in setting SMART treatment goals in the management of patients with post-stroke spasticity.

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Section: Discussionmentioning

confidence: 99%

Selecting Goals and Target Muscles for Botulinum Toxin A Injection Using the Goal Oriented Facilitated Approach to Spasticity Treatment (GO-FAST) Tool

Jacinto,

Balbert,

Bensmail

et al. 2023

Toxins

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“…Many patients with FD have a propensity towards falls and suffering adverse consequences such as fracture [2]. We have also calculated the lower limb parameters of the UPDRS scale and patient reported goals i.e., GAS goals which are increasingly considered important outcomes in rehabilitation research [13]. We found a significant reduction in pain besides the reduction in dystonia and improvement of other lower limb functional parameters with BT injection.…”

Section: Discussionmentioning

confidence: 88%

Spatiotemporal Gait Analysis and Lower Limb Functioning in Foot Dystonia Treated with Botulinum Toxin

Gupta

Tucker

Koblar

et al. 2018

Toxins

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Foot dystonia (FD) is a disabling condition causing pain, spasm and difficulty in walking. We treated fourteen (14) adult patients experiencing FD with onabotulinum toxin A injection into the dystonic foot muscles. We analyzed the spatiotemporal gait utilizing the GaitRite system pre- and 3 weeks post-botulinum toxin injection along with measuring dystonia by the Fahn–Marsden Dystonia Scale (FMDS), pain by the Visual Analog Scale (VAS) and other lower limb functional outcomes such as gait velocity, the Berg Balance Scale (BBS), the Unified Parkinson’s Disease Rating Scale–Lower Limb Score (UPDRS–LL), the Timed Up and Go (TUG) test and the Goal Attainment Scale (GAS). We found that stride length increased significantly in both the affected (p = 0.02) and unaffected leg (p = 0.01) after treatment, and the improvement in stride length was roughly the same in each leg. Similar results were found for step length (p = 0.02) with improvement in the step length differential (p = 0.01). The improvements in the lower limb functional outcomes were also significant—FMDS, VAS, TUG, and UPDRS–LL decreased significantly after treatment (all p < 0.001), and BBS (p = 0.001), GAS (p < 0.001) except cadence (p = 0.37). BT injection improved walking in foot dystonia as evidenced through gait analysis, pain and lower limb functional outcomes. Main study limitations were small sample size and lack of control.

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“…Secondary outcomes include changes inSpasticity measured by Modified Ashworth Scale (MAS)2 Min Walk Test [18]Berg Balance Score [19]Timed Up and Go (TUG) [20]Lower limb function by ABILICO [21]Goal Attainment Scale (GAS) [22]Quality of life by SF 12 (Rand version)ADL score -The Functional Autonomy Measurement System (SMAF) [23]Passive range of motion at the ankle joint.Use of ActivPAL to quantify ambulatory activities at home [25]…”

Section: Methods and Designmentioning

confidence: 99%

“…The aims of this study is to investigate the primary outcome of gait velocity by Gait Rite (Electronic Walkway) and the secondary outcomes are measuring spasticity by Modified Ashworth Scale (MAS), walking by 2 Min Walk Test [18]; balance by Berg Balance Scale [19]; mobility by Timed Up and Go (TUG) [20]; lower limb function by ABILICO [21]; patient related goal by Goal Attainment Scale (GAS) [22]; QOL by SF 12 (Rand version); activities of daily living by the Functional Autonomy Measurement System (SMAF) [23].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of botulinum toxin in modifying spasticity to improve walking and quality of life in post-stroke lower limb spasticity - a randomized double-blind placebo controlled study

et al. 2019

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Background Post-stroke lower limb spasticity (PSLLS) has a prevalence of 28–37%. PSLLS can cause difficulty in walking and reduce quality of life (QOL). Post stroke spasticity impairs the ability to intervene to improve walking ability. Botulinum Toxin A (BT) is an effective intervention for focal spasticity, but its use is currently restricted in many countries by their reimbursement system stating that the evidence for improvement in walking and quality of life (QOL) is not robust for treatment in the lower limb. This randomized control trial (RCT) will investigate the effectiveness of BT in modifying spasticity, and improving functioning (mobility, walking, activities of daily living (ADL’s) and QOL. Methods/design A double-blind placebo-controlled trial injection will assess the effect of BT compared with a placebo (normal saline) in a sample of n = 94 patients. Following treatment of spasticity measured by Modified Ashworth Scale (MAS), the primary outcome of gait velocity will be measured by i) Gait Rite (Electronic Walkway); ii) walking by 2 Min Walk Test; iii) balance by Berg Balance Scale; mobility by iv) Timed Up and Go (TUG); v) lower limb function by ABILICO; vi) patient related goal by Goal Attainment Scale (GAS); vii) QOL by SF 12 (Rand version); viii) activities of daily living by the Functional Autonomy Measurement System (SMAF). There will be an associated health economic analysis. Discussion The study methodology is based on our systematic review 2026 studies, which concluded the evidence for improving mobility following use of BT to reduce spasticity was not robust. The results of this study could establish the use of BT in improving gait and lower limb function in PSLLS. This study could provide the evidence needed for reimbursement schemes to consider and changes to its funding policy for BT in PSLLS. Trial registration The trial is registered with the Australia New Zealand Clinical Trails Registry (ANZCTR)- ANZCTRN12617001603303 . Registered 07/12/2017.

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

Cited by 6 publications

References 18 publications

Selecting Goals and Target Muscles for Botulinum Toxin A Injection Using the Goal Oriented Facilitated Approach to Spasticity Treatment (GO-FAST) Tool

Selecting Goals and Target Muscles for Botulinum Toxin A Injection Using the Goal Oriented Facilitated Approach to Spasticity Treatment (GO-FAST) Tool

Spatiotemporal Gait Analysis and Lower Limb Functioning in Foot Dystonia Treated with Botulinum Toxin

Efficacy of botulinum toxin in modifying spasticity to improve walking and quality of life in post-stroke lower limb spasticity - a randomized double-blind placebo controlled study

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