Predictors of real-world response in adults treated with botulinumtoxin-A for upper limb spasticity

Klemens Fheodoroff; Jorge Jacinto; Stephen Ashford; Natalya Danchenko; Anne Sophie Grandoulier; Guilhem Pietri; Yann Bourhis; Dean Spurden; Lynne Turner-Stokes

doi:10.1097/ph9.0000000000000030

Predictors of real-world response in adults treated with botulinumtoxin-A for upper limb spasticity

Klemens Fheodoroff^*, Jorge Jacinto, Stephen Ashford, Natalya Danchenko, Anne Sophie Grandoulier, Guilhem Pietri, Yann Bourhis, Dean Spurden, Lynne Turner-Stokes

^*Corresponding author for this work

Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation

Research output: Contribution to journal › Article › peer-review

Abstract

Background: To explore predictors of treatment response in adults receiving botulinumtoxin-A (BoNT-A) for upper limb spasticity (ULS) and to describe the association between response and concomitant medication, professional physical therapy, and quality of life (QoL). Methods: This was a secondary analysis of the longitudinal Upper Limb International Spasticity study (ULIS-III) data set. Eligible patients were adults receiving/initiating BoNT-A treatment for ULS in clinical practice. The treatment response was a goal attainment scaling (GAS) T score change of ≥10 points from baseline to follow-up for each cycle. Concomitant medication was recorded. Time spent on professional physical therapy and self-management was recorded using the Upper Limb Focal Spasticity Therapy Recording (ULSTR) schedule. QoL was assessed using the EQ-5D-5L questionnaire. Baseline patient and clinical characteristics were described. Factors predictive of treatment response were explored using stepwise multivariable regression modeling (linear or logistic as appropriate for the outcome) and backward elimination (α=0.1). Results: Overall, 828/981 patients had response data; 71.9% responded to BoNT-A therapy. Potential predictors of response identified were the use of injection guidance techniques (P=0.001), female sex (P=0.031), and abobotulinumtoxin-A therapy (vs. onabotulinumtoxin-A; P<0.001). Compared with nonresponders, responders had marginally lower use of concomitant medication, received marginally more professional physical therapy and (subgroup only) had improved QoL. Age, duration/distribution, severity of impairment, and previous BoNT-A had no predictive value. Conclusions: Future analyses of ULIS-III data will aim to validate these findings and further explore determinants of treatment response and the interplay between care modalities.

Original language	English
Pages (from-to)	24-32
Number of pages	9
Journal	Journal of the International Society of Physical and Rehabilitation Medicine
Volume	7
Issue number	1
DOIs	https://doi.org/10.1097/ph9.0000000000000030
Publication status	Published - 19 May 2024

Keywords

botulinumtoxin-A (BoNT-A)
goal attainment scaling (GAS)
physical therapy
quality of life
stroke rehabilitation

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10.1097/ph9.0000000000000030

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Fheodoroff, K., Jacinto, J., Ashford, S., Danchenko, N., Grandoulier, A. S., Pietri, G., Bourhis, Y., Spurden, D., & Turner-Stokes, L. (2024). Predictors of real-world response in adults treated with botulinumtoxin-A for upper limb spasticity. Journal of the International Society of Physical and Rehabilitation Medicine, 7(1), 24-32. https://doi.org/10.1097/ph9.0000000000000030

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title = "Predictors of real-world response in adults treated with botulinumtoxin-A for upper limb spasticity",

abstract = "Background: To explore predictors of treatment response in adults receiving botulinumtoxin-A (BoNT-A) for upper limb spasticity (ULS) and to describe the association between response and concomitant medication, professional physical therapy, and quality of life (QoL). Methods: This was a secondary analysis of the longitudinal Upper Limb International Spasticity study (ULIS-III) data set. Eligible patients were adults receiving/initiating BoNT-A treatment for ULS in clinical practice. The treatment response was a goal attainment scaling (GAS) T score change of ≥10 points from baseline to follow-up for each cycle. Concomitant medication was recorded. Time spent on professional physical therapy and self-management was recorded using the Upper Limb Focal Spasticity Therapy Recording (ULSTR) schedule. QoL was assessed using the EQ-5D-5L questionnaire. Baseline patient and clinical characteristics were described. Factors predictive of treatment response were explored using stepwise multivariable regression modeling (linear or logistic as appropriate for the outcome) and backward elimination (α=0.1). Results: Overall, 828/981 patients had response data; 71.9% responded to BoNT-A therapy. Potential predictors of response identified were the use of injection guidance techniques (P=0.001), female sex (P=0.031), and abobotulinumtoxin-A therapy (vs. onabotulinumtoxin-A; P<0.001). Compared with nonresponders, responders had marginally lower use of concomitant medication, received marginally more professional physical therapy and (subgroup only) had improved QoL. Age, duration/distribution, severity of impairment, and previous BoNT-A had no predictive value. Conclusions: Future analyses of ULIS-III data will aim to validate these findings and further explore determinants of treatment response and the interplay between care modalities.",

keywords = "botulinumtoxin-A (BoNT-A), goal attainment scaling (GAS), physical therapy, quality of life, stroke rehabilitation",

author = "Klemens Fheodoroff and Jorge Jacinto and Stephen Ashford and Natalya Danchenko and Grandoulier, {Anne Sophie} and Guilhem Pietri and Yann Bourhis and Dean Spurden and Lynne Turner-Stokes",

year = "2024",

month = may,

day = "19",

doi = "10.1097/ph9.0000000000000030",

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Fheodoroff, K, Jacinto, J, Ashford, S, Danchenko, N, Grandoulier, AS, Pietri, G, Bourhis, Y, Spurden, D & Turner-Stokes, L 2024, 'Predictors of real-world response in adults treated with botulinumtoxin-A for upper limb spasticity', Journal of the International Society of Physical and Rehabilitation Medicine, vol. 7, no. 1, pp. 24-32. https://doi.org/10.1097/ph9.0000000000000030

TY - JOUR

T1 - Predictors of real-world response in adults treated with botulinumtoxin-A for upper limb spasticity

AU - Fheodoroff, Klemens

AU - Jacinto, Jorge

AU - Ashford, Stephen

AU - Danchenko, Natalya

AU - Grandoulier, Anne Sophie

AU - Pietri, Guilhem

AU - Bourhis, Yann

AU - Spurden, Dean

AU - Turner-Stokes, Lynne

PY - 2024/5/19

Y1 - 2024/5/19

N2 - Background: To explore predictors of treatment response in adults receiving botulinumtoxin-A (BoNT-A) for upper limb spasticity (ULS) and to describe the association between response and concomitant medication, professional physical therapy, and quality of life (QoL). Methods: This was a secondary analysis of the longitudinal Upper Limb International Spasticity study (ULIS-III) data set. Eligible patients were adults receiving/initiating BoNT-A treatment for ULS in clinical practice. The treatment response was a goal attainment scaling (GAS) T score change of ≥10 points from baseline to follow-up for each cycle. Concomitant medication was recorded. Time spent on professional physical therapy and self-management was recorded using the Upper Limb Focal Spasticity Therapy Recording (ULSTR) schedule. QoL was assessed using the EQ-5D-5L questionnaire. Baseline patient and clinical characteristics were described. Factors predictive of treatment response were explored using stepwise multivariable regression modeling (linear or logistic as appropriate for the outcome) and backward elimination (α=0.1). Results: Overall, 828/981 patients had response data; 71.9% responded to BoNT-A therapy. Potential predictors of response identified were the use of injection guidance techniques (P=0.001), female sex (P=0.031), and abobotulinumtoxin-A therapy (vs. onabotulinumtoxin-A; P<0.001). Compared with nonresponders, responders had marginally lower use of concomitant medication, received marginally more professional physical therapy and (subgroup only) had improved QoL. Age, duration/distribution, severity of impairment, and previous BoNT-A had no predictive value. Conclusions: Future analyses of ULIS-III data will aim to validate these findings and further explore determinants of treatment response and the interplay between care modalities.

AB - Background: To explore predictors of treatment response in adults receiving botulinumtoxin-A (BoNT-A) for upper limb spasticity (ULS) and to describe the association between response and concomitant medication, professional physical therapy, and quality of life (QoL). Methods: This was a secondary analysis of the longitudinal Upper Limb International Spasticity study (ULIS-III) data set. Eligible patients were adults receiving/initiating BoNT-A treatment for ULS in clinical practice. The treatment response was a goal attainment scaling (GAS) T score change of ≥10 points from baseline to follow-up for each cycle. Concomitant medication was recorded. Time spent on professional physical therapy and self-management was recorded using the Upper Limb Focal Spasticity Therapy Recording (ULSTR) schedule. QoL was assessed using the EQ-5D-5L questionnaire. Baseline patient and clinical characteristics were described. Factors predictive of treatment response were explored using stepwise multivariable regression modeling (linear or logistic as appropriate for the outcome) and backward elimination (α=0.1). Results: Overall, 828/981 patients had response data; 71.9% responded to BoNT-A therapy. Potential predictors of response identified were the use of injection guidance techniques (P=0.001), female sex (P=0.031), and abobotulinumtoxin-A therapy (vs. onabotulinumtoxin-A; P<0.001). Compared with nonresponders, responders had marginally lower use of concomitant medication, received marginally more professional physical therapy and (subgroup only) had improved QoL. Age, duration/distribution, severity of impairment, and previous BoNT-A had no predictive value. Conclusions: Future analyses of ULIS-III data will aim to validate these findings and further explore determinants of treatment response and the interplay between care modalities.

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KW - goal attainment scaling (GAS)

KW - physical therapy

KW - quality of life

KW - stroke rehabilitation

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U2 - 10.1097/ph9.0000000000000030

DO - 10.1097/ph9.0000000000000030

M3 - Article

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SN - 2589-9457

VL - 7

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JO - Journal of the International Society of Physical and Rehabilitation Medicine

JF - Journal of the International Society of Physical and Rehabilitation Medicine

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ER -

Predictors of real-world response in adults treated with botulinumtoxin-A for upper limb spasticity

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