Mullins Denita, Winter Adele, Fini Natalie, Dixon Caroline, Aldous Sara, Palit Mithu, Holland Anne E
a Occupational Therapy Department , Caulfield Hospital, Alfred Health , Caulfield , Australia ;
b Physiotherapy Department , Caulfield Hospital, Alfred Health , Caulfield , Australia ;
Disabil Rehabil. 2016 Sep;38(19):1927-33. doi: 10.3109/09638288.2015.1107781. Epub 2015 Dec 30.
To determine which Goal Attainment Scale (GAS) goals are commonly achieved in patients with upper limb and/or lower limb spasticity following Botulinum Neurotoxin Type A (BoNT-A) injection.
Adults who attended a Spasticity Management Clinic for upper and/or lower limb BoNT-A injection were included in this prospective cohort study. Goals were set by participants and/or carers in conjunction with the therapist using the GAS, prior to injection and reviewed at one month following the injection. Three out of the five categories of goals were passive. Goals were categorised into: mobility/transfers, pain/comfort, upper limb use, hygiene, and cosmesis. The number of responders for the GAS total score, and in each of the GAS categories, was calculated.
Sixty-seven participants were recruited (mean age 51 ± 16 years; range 18-85), 70% had a stroke. Responders for mobility and transfer goals were further post injury or disease onset than non-responders (median 5.9 vs. 1.2 years, p = 0.03). Clients with stroke were less likely than other participants to achieve mobility and transfer goals (p = 0.02). There was a trend for those who achieved mobility and transfer goals to be younger (mean 49 years vs. 55 years, p = 0.06). Although active goals are more commonly identified, passive goals were more likely to be achieved.
Although active goals are commonly identified by people with spasticity, passive goals were more likely to be achieved following BoNT-A injection. A long duration of spasticity does not preclude patients from achieving mobility and transfer goals. Non-stroke participants were more likely to achieve mobility and transfer goals. Implications for Rehabilitation Patients with chronic spasticity should be considered for BoNT-A as clinically meaningful outcomes can be achieved. When spasticity is present in multiple muscles, the GAS can be an assistive tool to guide clinicians in determining which muscles are a priority for injection, because the client will be more motivated to improve those specific goals. Although carers and patients are more willing to set active goals, these are more difficult to achieve possibly because follow up intervention or independent practise is required.
确定在接受A型肉毒杆菌毒素（BoNT-A）注射后上肢和/或下肢痉挛患者中，哪些目标达成量表（GAS）目标通常能够实现。
参加上肢和/或下肢BoNT-A注射痉挛管理诊所的成年人被纳入这项前瞻性队列研究。在注射前，由参与者和/或护理人员与治疗师共同使用GAS设定目标，并在注射后一个月进行复查。五类目标中有三类是被动目标。目标分为：移动/转移、疼痛/舒适度、上肢使用、卫生和美观。计算GAS总分以及每个GAS类别中的应答者数量。
招募了67名参与者（平均年龄51±16岁；范围18 - 85岁），70%有中风病史。移动和转移目标的应答者受伤或发病后的时间比无应答者更长（中位数5.9年对1.2年，p = 0.03）。中风患者比其他参与者实现移动和转移目标的可能性更小（p = 0.02）。实现移动和转移目标的人有更年轻的趋势（平均49岁对55岁，p = 0.06）。虽然主动目标更常被确定，但被动目标更有可能实现。
虽然痉挛患者通常会确定主动目标，但注射BoNT-A后被动目标更有可能实现。长期的痉挛并不妨碍患者实现移动和转移目标。非中风参与者更有可能实现移动和转移目标。康复意义 慢性痉挛患者应考虑使用BoNT-A，因为可以实现具有临床意义的结果。当多块肌肉出现痉挛时，GAS可以作为一种辅助工具，指导临床医生确定哪些肌肉是注射的优先选择，因为患者会更有动力改善那些特定目标。虽然护理人员和患者更愿意设定主动目标，但这些目标更难实现，可能是因为需要后续干预或独立练习。
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