Goal Attainment: A Clinically Meaningful Measure of Success of Botulinum Toxin-A Treatment for Lower Limb Spasticity in Ambulatory Patients.
Subbuh Choudhry, Benjamin L Patritti, Richard Woodman and 2 others
PMID 34124643WHAT IT FOUND
Botulinum toxin reduced muscle tone but did not significantly change objective gait speed or other gait parameters.
However, most patients achieved their self-set goals. Goal attainment was higher in younger patients and those with low-functioning gait profiles, suggesting patient-centered goals capture benefits that standard gait tests miss.
Key findings
01Muscle tone significantly decreased after treatment, but there were no statistically significant changes in any of the 10 objective gait parameters.
02Most patients achieved their self-identified treatment goals or did better than expected, with goal attainment scores increasing significantly.
03Younger age and a low-functioning gait profile were associated with higher odds of achieving treatment goals.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was retrospective with no control group, making it impossible to rule out natural variation or placebo effects. The sample size was small (30 patients). Patients had heterogeneous causes of spasticity and varied durations of condition. The study could not determine if the number of previous BoNT-A treatments affected outcomes. Only a minority of patients participated in intensive rehabilitation, which might limit gait improvements. Objective gait parameters did not change, possibly because patients used maladaptive strategies to maintain speed, masking underlying deficits.
The easy way to misread this
Do not conclude that BoNT-A failed to improve walking. While objective gait speed did not change, most patients reported achieving their personal functional goals. Relying solely on standard gait metrics may underestimate the clinical benefit experienced by patients.