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.

Abstract

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. 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. 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. 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.