TY - JOUR
T1 - Goal attainment scaling in the evaluation of treatment of upper limb spasticity with botulinum toxin
T2 - A secondary analysis from a double-blind placebo-controlled randomized clinical trial
AU - Turner-Stokes, Lynne
AU - Baguley, Ian J.
AU - De Graaff, Stephen
AU - Katrak, Pesi
AU - Davies, Leo
AU - McCrory, Paul
AU - Hughes, Andrew
PY - 2010/1
Y1 - 2010/1
N2 - Objective: To examine goal attainment scaling for evaluation of treatment for upper limb post-stroke spasticity with botulinum toxin-A. Design: Secondary analysis of a multi-centre double-blind, placebo-controlled randomized clinical trial. Setting: Six outpatient clinics in Australia. Participants: Patients (n=90) completing per protocol 2 cycles of treatment/placebo. Mean age 54.5 (standard deviation 13.2) years. Mean time since stroke 5.9 (standard deviation 10.5) years. Interventions: Intramuscular botulinum toxin-A (Dysport® 500-1000U) or placebo given at 0 and 12 weeks. Measurement points were baseline, 8 and 20.weeks. Main outcome measures: Individualized goal attainment and its relationship with spasticity and other person-centred measures - pain, mood, quality of life and global benefit. Results: A significant treatment effect was observed with respect to goal attainment (Mann-Whitney z=-2.33,p≤0.02). Goal-attainment scaling outcome T-scores were highly correlated with reduction in spasticity (rho = 0.36,/?=0.001) and global benefit (rho = 0.45, p<0.001), but not with other outcome measures. Goal-attainment scaling T-scores were lower than expected (median 32.4, interquartile range 29.6-40.6). Goals related to passive tasks were more often achieved than those reflecting active function. Qualitative analysis of goals nevertheless demonstrated change over a wide area of patient experience. Conclusion: 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. Journal Compilation
AB - Objective: To examine goal attainment scaling for evaluation of treatment for upper limb post-stroke spasticity with botulinum toxin-A. Design: Secondary analysis of a multi-centre double-blind, placebo-controlled randomized clinical trial. Setting: Six outpatient clinics in Australia. Participants: Patients (n=90) completing per protocol 2 cycles of treatment/placebo. Mean age 54.5 (standard deviation 13.2) years. Mean time since stroke 5.9 (standard deviation 10.5) years. Interventions: Intramuscular botulinum toxin-A (Dysport® 500-1000U) or placebo given at 0 and 12 weeks. Measurement points were baseline, 8 and 20.weeks. Main outcome measures: Individualized goal attainment and its relationship with spasticity and other person-centred measures - pain, mood, quality of life and global benefit. Results: A significant treatment effect was observed with respect to goal attainment (Mann-Whitney z=-2.33,p≤0.02). Goal-attainment scaling outcome T-scores were highly correlated with reduction in spasticity (rho = 0.36,/?=0.001) and global benefit (rho = 0.45, p<0.001), but not with other outcome measures. Goal-attainment scaling T-scores were lower than expected (median 32.4, interquartile range 29.6-40.6). Goals related to passive tasks were more often achieved than those reflecting active function. Qualitative analysis of goals nevertheless demonstrated change over a wide area of patient experience. Conclusion: 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. Journal Compilation
KW - Botulinum toxin
KW - Goals
KW - Muscle spasticity
KW - Outcome assessment
UR - http://www.scopus.com/inward/record.url?scp=75649124911&partnerID=8YFLogxK
U2 - 10.2340/16501977-0474
DO - 10.2340/16501977-0474
M3 - Article
C2 - 20111849
AN - SCOPUS:75649124911
SN - 1650-1977
VL - 42
SP - 81
EP - 89
JO - Journal of Rehabilitation Medicine
JF - Journal of Rehabilitation Medicine
IS - 1
ER -