Longitudinal goal attainment with integrated upper limb spasticity management including repeat injections of botulinum toxin A: Findings from the prospective, observational Upper Limb International Spasticity (ULIS-III) cohort study.
Lynne Turner-Stokes, Jorge Jacinto, Klemens Fheodoroff and 4 others
PMID 33616192WHAT IT FOUND
In routine practice, repeated botulinum toxin injections helped most patients meet their goals.
Pain and passive movement goals were achieved more reliably than active hand function goals, which often required adjusting expectations over several cycles.
Key findings
01Overall, approximately 75% of all primary goals established in the study were achieved.
02Goal achievement was higher for passive function compared to active function.
03Most patients had 4 or fewer injections over 2 years, suggesting that, while 3-monthly injection cycles are permitted, they are not routine in clinical practice.
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
No control group or randomization, so it is impossible to attribute improvements solely to the injections rather than natural history or concomitant therapy. Missing data were not imputed, which may bias results if dropouts differed from completers. The study population was heavily skewed toward abobotulinumtoxinA, limiting comparisons between different botulinum toxin products. Goal setting was subjective, and although trained, the process may vary between clinicians and countries.
Declared interests
The study was part of the ULIS programme, which is associated with Merz Pharmaceuticals and Ipsen, manufacturers of botulinum toxin products. The authors acknowledge this observational design reflects real-life practice but do not explicitly state who funded the data collection in the provided text, though marketing authorization was ensured for each country.
The easy way to misread this
Do not interpret the positive goal attainment results as proof that botulinum toxin injections are superior to other interventions or that they work equally well for all goals. The study had no control group, and active function goals were achieved less often than passive or pain goals.