Article

OBJECTIVE: To examine goal attainment scaling for evaluation of treatment for
upper limb post-stroke spasticity with botulinum toxin-A.
DESIGN: Secondary
analysis of a multi-centre double-blind, placebo-controlled randomized clinical
trial. SETTING: Six outpatient clinics in Australia.
PARTICIPANTS: Patients
(n=90) completing per protocol 2 cycles of treatment/placebo. Mean age 54.5
(standard deviation 13.2) years. Mean time since stroke 5.9 (standard deviation
10.5) years. INTERVENTIONS: Intramuscular botulinum toxin-A (Dysport 500-1000U)
or placebo given at 0 and 12 weeks. Measurement points were baseline, 8 and 20
weeks. Main outcome measures: Individualized goal attainment and its relationship
with spasticity and other person-centred measures - pain, mood, quality of life
and global benefit. RESULTS: A significant treatment effect was observed with
respect to goal attainment (Mann-Whitney z=-2.33, p< or = 0.02). Goal-attainment
scaling outcome T-scores were highly correlated with reduction in spasticity
(rho=0.36, p=0.001) and global benefit (rho=0.45, p<0.001), but not with other
outcome measures. Goal-attainment scaling T-scores were lower than expected
(median 32.4, interquartile range 29.6-40.6). Goals related to passive tasks were
more often achieved than those reflecting active function.
Qualitative analysis
of goals nevertheless demonstrated change over a wide area of patient experience.
Conclusion: Goal-attainment scaling provided a responsive measure for evaluating
focal intervention for upper limb spasticity, identifying outcomes of importance to the individual /carers, not otherwise identifiable using standardized measures.

Langue : ANGLAIS