Real-life outcomes in spasticity management: features affecting goal achievement

Abstract

Background/objective: Spasticity is a complex and common condition but there is a lack of 'real-world' data on goal setting and spasticity treatment, as well as identifying those features that might be associated with goal achievement. Our aim was to provide such data.

Methods: Prospective attenders at a multi-disciplinary spasticity clinic over 2 years followed for consecutive appointments. Patient demographics and doses of botulinum toxin injected were documented. Main outcome was achievement of a primary goal but secondary goals were also recorded. Independent variables were examined for association to the outcome.

Results: A total of 606 goals were set in 224 patients. The majority (75.2%) were achieved with similar levels across active (72.5%), passive (75.7%) and pain (78.6%) goals. However, in terms of the primary goal, active primary goals were achieved less frequently (59.7%) than non-active primary goal (74.2%). A logistic regression confirmed that this was the only independent variable associated with primary goal achievement. The majority of patients (61.6%) required changes to their treatment between appointments, irrespective of time since diagnosis, age or aetiology.

Conclusions: Most goals set in spasticity clinic can be achieved irrespective of type of goal. However, active goals may be harder to accomplish when they are set as a primary goal. This may reflect the desire of individuals to prioritise a desirable goal rather than one that is achievable. While goal setting is important in the management of spasticity patients, very few patient or treatment factors are associated with outcome prediction. Further work needs to identify features that may predict successful outcome.

Keywords: botulinum toxin; rehabilitation; spasticity; stroke; traumatic brain injury.

Figure 1

Muscles injected in 206 individuals. Adduc, adductor compartment thigh; BB, biceps/brachialis; BR, brachioradialis; FCR, flexor carpi radialis; FCU, flexor carpi ulnaris; FDL, flexor digitorum longus; FDP, flexor digitorum profundus; FDS, flexor digitorum superficialis; FHB, flexor hallucis brevis; FHL, flexor hallucis longus; FPL, flexor pollicis longus; HS, hamstrings; PT, pronator teres; TP, tibialis posterior.