NSW Brain Injury Rehabilitation Forum May 2011

 

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Goal attainment following upper-limb Botulinum Toxin-A injections: are we facilitating achievement of client goals?
HANNAH BARDEN, Westmead Hospital

 

Title: Goal attainment following upper-limb Botulinum Toxin-A injections: Are we facilitating achievement of client centred goals?

Author: Hannah Barden

Introduction: The need for client-centred outcome measures following upper-limb (UL) Botulinum Toxin-A (BoNT-A) injections is being increasingly understood.

Aims: Evaluate UL goal attainment following BoNT-A injections and describe client-centred goals of adults with UL spasticity following brain impairment.

Methods: 23 participants were recruited from three spasticity clinics. A pre-testJpost-test design evaluated UL spasticity using the Modified Ashworth Scale (MAS), Tardieu Spasticity Angle (TSA), and Goal Attainment Scale (GAS) prior to and 4 weeks after injections. Data were analysed using chi-square, Mann Whitney U, and paired t-tests.

Results: Participants identified self care, home management, leisure, productivity, mobility and symptom management goals. Half the goals were achieved at 4-weeks post injection (23/45 goals achieved). The nature of goals (occupational area; active versus passive) was not associated with goal achievement. GAS T-scores improved significantly following BoNT-A injections (t= -5.69; p<.001). MAS scores at the elbow, wrist and fingers reduced significantly (z = -2.05, P = .04; z = -2.55, P = .01; z = -3.40, P = .001). Mean TSA of the wrist reduced from 27 ° to 13 ° (t = 2.54, P = .02). Differences in mean TSA at the elbow and fingers were clinically, but not statistically significant (Elbow: 49°to 32°; Fingers: 27°to 22°).

Conclusion: Consideration of goal attainment following BoNT-A injections for UL spasticity proides a client- centred process for measuring outcome and broadens the focus of spasticity outcome measurement from body structure/function to activity and participation.