Patient-centred and daily life-oriented botulinum toxin treatment for stroke survivors with upper extremity spasticity – effects and practical aspects

Background/Objectives: To investigate the impact of a routine botulinum toxin type A (BoNT-A) injection in combination with outpatient therapy on daily activities of stroke survivors with upper extremity spasticity and to facilitate patient-centred assessment focusing on individual needs during daily life.

Methods:

Design: Observational study across one treatment cycle (3 months).

Setting: Spasticity outpatient clinic of a neurorehabilitation hospital in Germany.

Participants: Adult stroke survivors (n=27) with upper extremity spasticity receiving routine BoNT-A treatment.

Interventions: Participants received one BoNT-A injection and outpatient therapies as part of their routine management. Augmented assessment was conducted directly before injection (T0), at four to six weeks (Tmax1) and 12 to 14 weeks (T2) following injection. Main outcome measures: Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling (GAS), Arm Activity Measure (ArmA).

Secondary outcome measures: Resistance to Passive Movement Scale (REPAS), Motricity Index (MI), SF-12v2 Health Survey (SF-12v2), Global Clinical Impression (GCI) and importance of and satisfaction with the BoNT-A treatment.

Results: Performance of individually selected daily activities and satisfaction with their performance (COPM), passive care tasks (ArmA, part A) and resistance to passive movement (REPAS) significantly improved from T0 to Tmax1. Improvements largely remained at T2. Individual goals were all set at the activities and participation levels of the International Classification of Functioning, Disability and Health. These improved for 75% of participants and were fully attained by 33.3% at Tmax1. Responder analysis indicated that COPM and ArmA improvements were clinically significant for up to 50% of participants. Active upper extremity use (ArmA, part B), health-related quality of life (SF-12v2), and upper extremity strength (MI) remained unchanged.

Conclusions: Our results indicate that BoNT-A in combination with routine outpatient therapy positively influenced individually valued daily activities of stroke survivors. COPM, GAS and ArmA are suitable to facilitate a patient-centred and daily life-oriented spasticity management post-stroke.