Eftekhar Parvin, Mochizuki George, Dutta Tilak, Richardson Denyse, Brooks Dina
Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada.
Toronto Rehabilitation Institute, Toronto, Ontario, Canada.
Occup Ther Int. 2016 Dec;23(4):379-389. doi: 10.1002/oti.1440. Epub 2016 Oct 3.
Focusing on rehabilitation goals is an effective approach for improving function in individuals with spasticity after stroke. The objectives of this study were to examine and map goals of post-stroke individuals with spasticity using the Goal Attainment Scale (GAS) and International Classification of Functioning, Disability and Health (ICF), and to evaluate the impact of botulinum toxin A (BoNTA) on occupational performance based on the type of rehabilitation goals. Thirty-one patients were recruited from an outpatient spasticity management clinic. Each patient set one goal, was injected with BoNTA in their spastic upper limb muscles and received standard rehabilitation services twice a week for four weeks. Twenty-seven participants achieved the expected level, and four exceeded the expected level of their rehabilitation goals. Fifty-five percent of the goals were related to Activity/Participation, and 45% of the goals were categorized in the Body Structures and Function domain of the ICF. Fifteen goals focused on positioning, while 16 goals focused on (independent) activities of daily living (ADL/IADL). Both the positioning and ADL/IADL groups experienced a reduction in MAS following the administration of BoNTA. The positioning group was older and more impaired. Mapping goals to ICF identifies specific targets for intervention, establishes a common language within the interdisciplinary team and contextualizes the ways disability impacts goals. This study is limited by a relatively small sample size and absence of a functional measure. Further studies can explore the development of goal/item banks to advance the use of GAS for spasticity management. Copyright © 2016 John Wiley & Sons, Ltd.
关注康复目标是改善中风后痉挛患者功能的有效方法。本研究的目的是使用目标达成量表（GAS）和国际功能、残疾和健康分类（ICF）来检查和描绘中风后痉挛患者的目标，并根据康复目标的类型评估A型肉毒毒素（BoNTA）对职业表现的影响。从门诊痉挛管理诊所招募了31名患者。每位患者设定一个目标，在其痉挛的上肢肌肉中注射BoNTA，并每周接受两次标准康复服务，持续四周。27名参与者达到了预期水平，4名超过了康复目标的预期水平。55%的目标与活动/参与相关，45%的目标归类于ICF的身体结构和功能领域。15个目标侧重于体位摆放，16个目标侧重于（独立）日常生活活动（ADL/IADL）。在注射BoNTA后，体位摆放组和ADL/IADL组的改良Ashworth量表（MAS）评分均有所降低。体位摆放组年龄更大且功能障碍更严重。将目标映射到ICF可确定具体的干预靶点，在跨学科团队中建立通用语言，并将残疾影响目标的方式情境化。本研究受样本量相对较小和缺乏功能测量的限制。进一步的研究可以探索目标/项目库的开发，以推进GAS在痉挛管理中的应用。版权所有© 2016约翰·威利父子有限公司。
