Interdisciplinary spasticity management clinic outcomes using the Goal Attainment Scale: A retrospective chart review
Amy Hanlan, Patricia Mills, Rachel Lipson, Heather Finlayson
Division of Physical Medicine & Rehabilitation, University of British Columbia, V5Z2G9 Vancouver, Canada
Objective: To generate practice-based evidence of outcomes in an interdisciplinary spasticity management clinic using practical application of the Goal Attainment Scale (GAS).
Design: Retrospective chart review.
Patients: A total of 225 adult patients who were referred for spasticity management at a tertiary rehabilitation hospital and returned for follow-up between 2010 and 2013.
Methods: GAS scores were determined for all patients. GAS T-scores were evaluated based on age; sex; diagnosis; International Classification of Functioning, Disability and Health (ICF) domain; body region affected; and site of botulinum neurotoxin injection.
Results: The distribution of GAS outcomes did not vary by age, sex or diagnosis. The overall GAS T-score for the clinic was 47.7, which is consistent with appropriate goal setting. GAS T-scores did not vary by diagnosis or ICF domain. Significant intervention effects were identified for botulinum neurotoxin, with improvements in GAS T-scores for treatment targeted to both upper and lower limb muscles, compared with no botulinum neurotoxin, across diagnoses and ICF domains.
Conclusion: The GAS is a useful patient-centred outcome measure that can be practically applied in the clinical setting for a heterogeneous population with diverse goals. Botulinum neurotoxin treatment in this setting was associated with improved goal attainment relating to multiple ICF domains.
Spasticity is a condition in which there are uncontrolled muscle contractions that cause a wide range of problems. Examples include difficulty moving a “stuck” limb; pain; challenges with dressing; tripping while walking; and skin wounds. Spasticity affects people with neurological diseases such as stroke, brain injury, spinal cord injury, multiple sclerosis, and cerebral palsy. In this study, we showed how a team-based approach to spasticity management can help to determine and achieve individualized goals with interventions including physiotherapy, occupational therapy, bracing, oral medications, and botulinum toxin injections. This provides a “real-world” example of how health care providers, patients, and families can work together to optimize patient outcomes.
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