Session Information
Date: Thursday, November 14, 2019
Session Title: Neurological Rehabilitation Research Report
Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 6
Disclosures: Klemens Fheodoroff, MD: Nothing to disclose
Objective: The Upper Limb International Spasticity (ULIS) program is a series of observational cohort studies across >30 countries. Since its start in 2008, its large scale and focus on systematic evaluation of goal achievement has helped change clinical practice. This analysis explores changes in goal setting and achievement between the second and third stages of the program (ULIS-II and ULIS-III) to explore how the process of goal setting has evolved in long-term spasticity management with botulinum toxin-A (BoNT-A).
Design: Prospective observational studies (NCT01020500 and NCT02454803). Each phase of the program is supported by extensive investigator training.
Setting: International multicenter studies conducted in secondary care centers.
Participants: Adults (≥18 years) with upper limb spasticity.
Interventions: Patients are treated with BoNT-A per routine practice. ULIS-II was a single cycle study whereas ULIS-III examined outcomes from repeated BoNT-A cycles over 2 years.
Main Outcome Measures: Goal Attainment Scaling.
Results: Study comparisons showed progress in the types of goals set. Whereas the frequency of primary goals increased for pain (from 13.4% in ULIS-II to 25.3% in ULIS-III), reduction of involuntary movement (from 9.0% to 13.3%) and passive function (from 28.9 to 30.7%), rates of goal setting decreased for active function (from 22.8% to 15.0%) and range of movement (from 23.0% to 13.9%). Patterns of injection evolved in line with goal setting. For example, the rate of shoulder injections increased from 32.0% to 39.4% – mainly reflecting the increased recognition of pain as a primary goal. Overall rates of goal achievement fell from 79.6% in ULIS-II to 69.4% in ULIS-III, reflecting a tighter definition of goals.
Conclusions: Over the past decade, the ULIS program provides a description of the evolution of routine spasticity management as clinicians develop how they support their patients setting relevant and achievable treatment goals.
Level of Evidence: Level II
To cite this abstract in AMA style:
Fheodoroff K, Ashford S, Jacinto J, Maisonobe P, Lysandropoulos A, Turner-Stokes LF. Goal Setting for Botulinum Toxin Injections: Impact of the Upper Limb International Spasticity (ULIS) Programme [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/goal-setting-for-botulinum-toxin-injections-impact-of-the-upper-limb-international-spasticity-ulis-programme/. Accessed May 12, 2025.« Back to AAPM&R Annual Assembly 2019
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/goal-setting-for-botulinum-toxin-injections-impact-of-the-upper-limb-international-spasticity-ulis-programme/