Stephen Ashford1, Klemens Fheodoroff2, Jorge Jacinto3, Lynne Turner-Stokes4. 1. Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK King's College London, Faculty of Life Science and Medicine, Department of Palliative Care, Policy and Rehabilitation, UK Stephen.Ashford@nhs.net. 2. Department of Neurorehabilitation, Gailtal-Klinik, Hermagor, Austria. 3. Centro de Medicina de Reabilitaçãode Alcoitão, Serviço de Reabilitação de Adultos 3, Estoril, Portugal. 4. Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK King's College London, Faculty of Life Science and Medicine, Department of Palliative Care, Policy and Rehabilitation, UK.
Abstract
OBJECTIVE: We aimed to develop a goal classification of individualised goals for spasticity treatment incorporating botulinum toxin intervention for upper limb spasticity to under-pin a more structured approach to future goal setting. DESIGN: Individualised goals for spasticity treatment incorporating botulinum toxin intervention for upper limb spasticity (n=696) were analysed initially from four studies published in 2008-2012, spanning a total of 18 centres (12 in the UK and 6 in Australia). Goals were categorised and mapped onto the closest matching domains of the WHO International Classification of Functioning. Confirmatory analysis included a further 927 goals from a large international cohort study spanning 22 countries published in 2013. RESULTS: Goal categories could be assigned into two domains, each subdivided into three key goal areas: Domain 1: symptoms/impairment n=322 (46%): a. pain/discomfort n=78 (11%), b. involuntary movements n=75 (11%), c. range of movement/contracture prevention n=162 (23%). Domain 2: Activities/function n=374 (54%): a. passive function (ease of caring for the affected limb) n=242 (35%), b active function (using the affected limb in active tasks) n=84 (12%), c. mobility n=11 (2%).Over 99% of the goals from the large international cohort fell into the same six areas, confirming the international applicability of the classification. CONCLUSIONS: Goals for management of upper limb spasticity, in worldwide clinical practice, fall into six main goal areas.
OBJECTIVE: We aimed to develop a goal classification of individualised goals for spasticity treatment incorporating botulinum toxin intervention for upper limb spasticity to under-pin a more structured approach to future goal setting. DESIGN: Individualised goals for spasticity treatment incorporating botulinum toxin intervention for upper limb spasticity (n=696) were analysed initially from four studies published in 2008-2012, spanning a total of 18 centres (12 in the UK and 6 in Australia). Goals were categorised and mapped onto the closest matching domains of the WHO International Classification of Functioning. Confirmatory analysis included a further 927 goals from a large international cohort study spanning 22 countries published in 2013. RESULTS: Goal categories could be assigned into two domains, each subdivided into three key goal areas: Domain 1: symptoms/impairment n=322 (46%): a. pain/discomfort n=78 (11%), b. involuntary movements n=75 (11%), c. range of movement/contracture prevention n=162 (23%). Domain 2: Activities/function n=374 (54%): a. passive function (ease of caring for the affected limb) n=242 (35%), b active function (using the affected limb in active tasks) n=84 (12%), c. mobility n=11 (2%).Over 99% of the goals from the large international cohort fell into the same six areas, confirming the international applicability of the classification. CONCLUSIONS: Goals for management of upper limb spasticity, in worldwide clinical practice, fall into six main goal areas.
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