Goal attainment for spasticity management using botulinum toxin

Abstract

Background and purpose: To determine whether goal attainment scaling (GAS) can demonstrate functional gains following injection of botulinum toxin (BTX) for spasticity in severely disabled patients.

Method: Subjects were categorized as 'responder' (positive clinical outcome) and 'non-responder' (non-significant clinical outcome) on the basis of their overall clinical response. GAS scores for functional goals were calculated retrospectively and compared with standard outcome assessments undertaken at the time of intervention. Integrated care pathway (ICP) proformas were interrogated for 18 patients with acquired brain injuries. Mean age was 44.4 (SD 13.4) years.

Results: Baseline GAS and Barthel scores were similar for the responder and non-responder groups. The outcome GAS score was significantly greater in the responder than in the non-responder group (Mann-Whitney U = 11.0; p = 0.011) as was the change in GAS score (Mann-Whitney U = 8.0; p = 0.004). GAS scores reflected change recorded in focal outcome measures. However, the Barthel Index measured change in only one case.

Conclusions: This exploratory retrospective study provides preliminary support for the hypothesis that GAS provides a useful measure of functional gains in response to treatment with BTX, and is more sensitive than global measures such as the Barthel Index.