Goal Attainment after Treatment with Abobotulinumtoxina and a Tailored Home Therapy Programme in Children with Upper Limb Spasticity: Descriptive, Exploratory Analysis of a Large Randomized, Controlled Study

Abstract

Objective: This exploratory analysis of a large, randomized, double-blind study (NCT02106351) describes the effect of treatment with abobotulinumtoxinA followed by a tailored home exercises therapy programme in enabling children with upper limb spasticity due to cerebral palsy to achieve their functional goals using goal attainment scaling (GAS).

Methods: Children with cerebral palsy and spasticity in ≥ 1 upper limb received up to 4 injection cycles of abobotulinumtoxinA (2 U/kg (cycle 1 only), 8U/kg and 16U/kg) into the elbow and wrist flexors and other upper limb muscles selected to support individual treatment goals. Children followed a home exercises therapy programme, which included stretches and exercises specifically chosen to facilitate goal achievement and engagement in activities.

Results: For cycle 1, most children had active function goals set as their primary goal (69.7% vs 19.2% passive function goals). GAS T- scores and goal responder rates at week 16 indicated that most types of primary goal were achieved at least as expected during cycle 1 (all groups). Primary goal GAS T-scores were generally maintained for the first 3 abobotulinumtoxinA treatment cycles.

Conclusion: Most children with upper limb spasticity treated with repeat cycles of abobotulinumtoxinA supported by an individualized home exercises therapy programme achieved their functional goals.

Figures

Box 1

Case studies of goal-setting, goal-guided treatment, and goal attainment

Box 1

Case studies of goal-setting, goal-guided treatment, and goal attainment

Box 1

Case studies of goal-setting, goal-guided treatment, and goal attainment

Box 1

Case studies of goal-setting, goal-guided treatment, and goal attainment

Fig. 1

Primary goal attainment by goal domains at week 16 of cycle 1 (modified intention-to-treat (mITT) population).

Fig. 2

Rates of goal achievement at week 16 of cycle 1 by goal domain (including primary and secondary goals, modified intention-to-treat (mITT) population). Goal achievement defined as goal attainment scaling (GAS) score ≥ 0.

Fig. 3

(a) Goal attainment and (b) goal achievement at weeks 6 and 16 across cycles 1–4 (aboBoNT-A 8 and 16 U/kg combined). Responders were defined as the proportion of primary goals achieved where goal achievement was defined as goal attainment scaling (GAS) score ≥ 0.