Goal Attainment after Treatment with Abobotulinumtoxina and a Tailored Home Therapy Programme in Children with Upper Limb Spasticity: Descriptive, Exploratory Analysis of a Large Randomized, Controlled Study.
Jorge Carranza-Del Río, Nigar Dursun, Cigdem Cekmece and 9 others
PMID 36306168WHAT IT FOUND
Children achieved their upper limb goals when botulinum toxin was paired with a tailored home therapy programme.
Goal attainment was generally maintained across three treatment cycles, but dropped below expectations in the fourth cycle for children with more severe motor impairment.
Key findings
01Children attained their primary goals on average at least as expected across all three initial treatment cycles, with no significant difference between the 2, 8, and 16 U/kg dose groups.
02Overall goal attainment scores fell below the expected threshold in cycle 4, and fewer children achieved their goals compared to earlier cycles.
03Children who required four treatment cycles were older and had higher GMFCS scores, indicating greater motor impairment, and their goal attainment dropped in later cycles.
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 did not include a control group receiving only the home therapy programme without botulinum toxin, making it difficult to separate the effects of the injection from the therapy. The same therapists who set the goals also evaluated the outcomes, which could introduce bias. Children with bilateral cerebral palsy (GMFCS III-IV) were less well represented, limiting generalizability to this group. The study used fixed dose randomization, which does not reflect clinical practice where doses are tailored to the individual's presentation.
Declared interests
The study was industry-sponsored. Physicians and families were aware that all children would receive abobotulinumtoxinA, which could have influenced expectations and outcome assessments.
The easy way to misread this
Do not interpret the drop in goal attainment in cycle 4 as evidence that the treatment stops working. The decline was specific to children with more severe motor impairment who likely progressed to more difficult goals, and the study cannot separate the effects of the toxin from the high compliance with the home therapy programme.