Evolution of goal setting and attainment over repeated cycles of botulinum toxin A for upper limb spasticity in real-life clinical practice: longitudinal analyses from the observational ULIS-III cohort study
DOI:
https://doi.org/10.2340/jrm.v58.45139Keywords:
botulinum toxin A, goal attainment scaling, post-stroke spasticity, physical therapies, stroke rehabilitationAbstract
Objective: This post-hoc analysis evaluated how goal attainment evolved over repeated cycles of botulinum toxin A (BoNT-A) treatment in adults with upper-limb spasticity.
Methods: ULIS-III (NCT02454803) was a 2-year observational study involving adults treated with BoNT-A. The analysis included 538 patients who received ≥ 4 BoNT-A injection cycles and had Goal Attainment Scaling (GAS) assessments for each of the first 4 cycles. GAS T-scores were used to measure treatment response. Multivariate models assessed predictors of achieving a GAS T-score ≥ 50 and being in the top tertile (best) of responders.
Results: Patients generally maintained consistent goal domains across cycles. Mean change in GAS T-scores remained above the minimal clinically important difference of 10 throughout. The proportion of patients achieving a GAS T-score ≥ 50 increased from 64.5% in Cycle 1 to 75.8% in Cycle 4. Use of injection guidance techniques significantly increased the odds of achieving treatment goals (OR 1.92; 95% CI 1.45–2.55) and being a “best” responder (OR 2.44; 95% CI 1.47–4.06). Higher BoNT-A doses were also associated with better outcomes.
Conclusions: Repeated BoNT-A treatment supports sustained goal attainment in upper limb spasticity. Success rates improve with each cycle, particularly when guided injection techniques are used.
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Copyright (c) 2026 Lynne Turner-Stokes, Klemens Fheodoroff, Jorge Jacinto, Mathieu Beneteau , Pascal Maisonobe, Christian Hannes, Stephen Ashford
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