Disclosures: Lynne F. Turner Stokes, DM, FRCP: Ipsen (Products/Services: Yes) (Consultant/Advisory Board, Honorarium, Research Grant includes principal investigator, collaborator or consultant and pending grants as well as grants already received, Speaker/Honoraria includes speakers bureau, symposia, and expert witness)

Objective: Assess the longitudinal effects of integrated spasticity management incorporating repeated cycles of botulinum toxin A (BoNT-A) over 2 years.

Design: Prospective, observational cohort study (NCT02454803). Setting : International, multicenter study. Participants : Adults (≥18 years) with upper limb spasticity.

Interventions: Patients were treated with BoNT-A per routine practice.

Main Outcome Measures: ULIS-III was the first study to use the Upper Limb Spasticity Index (ULSI), an assessment battery including a structured approach to goal attainment scaling (GAS) alongside a set of standardized measures. Patients continued with their usual concomitant therapies, which were recorded in the Upper Limb Focal Spasticity Therapy Recording Schedule (ULSTR) to document the number/duration/type of therapies related to specific goals.

Results: 1004 patients were enrolled (14 countries), of which 953 underwent ≥1 BoNT-A injection cycle and had ≥1 GAS assessment. Patients underwent a median [range] of 4 [1–9] BoNT-A injection cycles. A majority of patients (55.9–64.6% across cycles 1–6) saw a therapist after BoNT-A treatment; the most frequent intervention was passive stretch (70.1–79.8% across cycles 1–6). Patients achieved their goals as expected over repeated cycles; mean [95% CI] GAS T scores at Baseline were 36.7 [36.5, 36.9] and mean cumulated GAS T scores at 2 years was 49.5 [49.1, 49.9]. Mean GAS change scores of ≥10 were maintained across the first 6 cycles (ranging from a mean±SD change of 13.0±8.4 in Cycle 1 to 10.6±6.9 in Cycle 6). Higher rates of goal achievement were seen for primary goals related to passive vs. active function (86.6% vs 71.4% achievement). Standardized measures of spasticity, pain, involuntary movements, active and passive function improved over each treatment cycle. Conclusions: This large, international study provides evidence for benefit of repeated cycles of BoNT-A, sustained over 2 years captured through person-centered goal attainment and standardized measures.

Level of Evidence: Level II

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/longitudinal-goal-attainment-with-integrated-upper-limb-spasticity-management-including-botulinum-toxin-a-primary-results-from-the-ulis-iii-study/