Goal attainment following upper-limb botulinum toxin-A injections: Are we facilitating achievement of client-centred goals?
Melissa T. Nott, Hannah L. H Barden, Ian J. Baguley
School of Community Health, Charles Sturt University, Albury, Australia. E-mail: firstname.lastname@example.org
Objectives: Evaluate upper-limb goal attainment following botulinum toxin-A, map goals to the International Classification of Functioning, Disability and Health (ICF) and explore associations between client goals, clinical indicators of spasticity and the Botulinum Toxin-A injection strategy adopted by the treating physician.
Participants: Twenty-eight community-dwelling adults with acquired brain injury.
Methods: Goal attainment was measured using the Goal Attainment Scale (GAS) 4 weeks post-injection. Goals were linked to the ICF. Clinical measures including the Modified Ashworth Scale (MAS), Tardieu Spasticity Angle (TSA) and Action Research Arm Test (ARAT) were collected pre-injection for determining association with injection strategy.
Results: Goals represented the ICF domains of Body Structure/Function and Activity/Participation. Approximately half
the goals were achieved 4 weeks post-injection and GAS T-scores improved significantly. Activity/Participation goals were equally likely to be achieved as Body Structure/Function goals. Pre-injection ARAT scores were correlated with GAS change, whereas MAS and TSA scores were not. TSA was a stronger indicator of muscle selection for botulinum toxin-A injections than MAS. Goals were directly associated with botulinum toxin-A injections for distal hand function, but not for proximal upper-limb function.
Conclusion: Goal setting and review provides a clinically useful process for measuring upper-limb botulinum toxin-A outcomes.
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