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Fheodoroff K, Danchenko N, Whalen J, Balcaitiene J, Magalhães B, Szulc E, Zaffalon A, Burchakova M, Nechiporenko D, Robbins S. Modelling long-term outcomes and risk of death for patients with post-stroke spasticity receiving abobotulinumtoxina treatment and rehabilitation therapy. J Rehabil Med 2022; 54:jrm00303. [PMID: 35844200 PMCID: PMC9422883 DOI: 10.2340/jrm.v54.2422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Stroke is associated with a high risk of death and cardiovascular events. Rehabilitation therapy is critical for functional recovery, to reduce hospital readmissions, all-cause and cardiovascular mortality, and stroke recurrence (long-term outcomes). Post-stroke spasticity may prevent effective recovery by restricting mobility. AbobotulinumtoxinA is an adjunctive therapy to physical therapy for post-stroke spasticity, but its long-term effects are unknown. The objective was to model the long-term clinical and economic outcomes of abobotulinumtoxinA for post-stroke spasticity. Methods Effects of abobotulinumtoxinA on treating post-stroke spasticity and evidence linking functional outcomes with long-term outcomes were collected in a focused literature review. A model was developed to estimate health benefits on long-term outcomes, direct medical costs, life- and quality-adjusted life-years for abobotulinumtoxinA injections plus rehabilitation therapy compared with rehabilitation therapy alone, from a UK perspective over a 10-year time-period. Results AbobotulinumtoxinA + rehabilitation therapy led to a risk reduction of 8.8% for all-cause mortality, and an increase of 13% in life-years and 59% in quality-adjusted life-years compared with rehabilitation therapy alone. AbobotulinumtoxinA + rehabilitation therapy was considered cost-effective compared with rehabilitation therapy alone (incremental cost-effectiveness ratio: £24,602). Conclusion AbobotulinumtoxinA + rehabilitation therapy may improve long-term outcomes, including post-stroke survival, while being cost-effective for the treatment of post-stroke spasticity.
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Balcaitiene J, Danchenko N, Zaffalon A, Robbins S, Szulc E, Magalhães B, Burchakova M, Nechiporenko D, Whalen J. Modelling Long-Term Outcomes and Mortality Risk for Post-Stroke Spasticity Patients on AbobotulinumtoxinA Treatment and Rehabilitation Therapy. Toxicon 2022. [DOI: 10.1016/j.toxicon.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Lejeune T, Khatkova S, Turner-Stokes L, Picaut P, Maisonobe P, Balcaitiene J, Boyer FC. Corrigendum to AbobotulinumtoxinA injections in shoulder muscles to improve adult upper limb spasticity: Results from a phase 4 real-world study and a phase 3 open-label trial. J Rehabil Med 2021; 53:jrm00187. [PMID: 33937918 PMCID: PMC8814836 DOI: 10.2340/16501977-2830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Thierry Lejeune
- Physical Medicine and Rehabilitation Department, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, BE-1200 Brussels, Belgium
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Lejeune T, Khatkova S, Turner-Stokes L, Picaut P, Maisonobe P, Balcaitiene J, Boyer FC. Abobotulinumtoxina injections in shoulder muscles to improve adult upper limb spasticity: Results from a phase 4 real-world study and a phase 3 open-label trial. J Rehabil Med 2020; 52:jrm00068. [PMID: 32451555 DOI: 10.2340/16501977-2695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Botulinum toxins, such as abobotulinumtoxinA, are used to treat spasticity (muscle overactivity) in arm muscles. Spasticity in shoulder muscles occurs in many patients following a stroke. Shoulder spasticity can be painful and limit limb movement. This paper compares the results from patients who did and those who did not receive abobotulinumtoxinA injections in shoulder muscles (among other arm muscles) in 2 studies. In both studies, the results showed that more patients receiving treatment in shoulder muscles chose pain as a key goal for treatment and had reduced pain following treatment compared with patients not treated in the shoulder. In addition, patients receiving shoulder injections showed further improvement in arm movement compared with those not receiving shoulder injections. Overall, these results suggest that abobotulinumtoxinA treatment in shoulder muscles may improve outcomes for patients with arm spasticity involving the shoulder.
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Affiliation(s)
- Thierry Lejeune
- Physical Medicine and Rehabilitation Department, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, BE-1200 Brussels, Belgium. E-mail:
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Bayle N, Maisonobe P, Raymond R, Balcaitiene J, Gracies JM. Composite active range of motion (CX A) and relationship with active function in upper and lower limb spastic paresis. Clin Rehabil 2020; 34:803-811. [PMID: 32336148 PMCID: PMC7263039 DOI: 10.1177/0269215520911970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate a novel composite measure of active range of motion (XA) and determine whether this measure correlates with active function. DESIGN Post hoc analysis of two randomized, placebo-controlled, double-blind studies with open-label extensions exploring changes in active function with abobotulinumtoxinA. SETTING Tertiary rehabilitation centers in Australia, Europe, and the United States. SUBJECTS Adults with upper (n = 254) or lower (n = 345) limb spastic paresis following stroke or brain trauma. INTERVENTIONS AbobotulinumtoxinA (⩽5 treatment cycles) in the upper or lower limb. MAIN MEASURES XA was used to calculate a novel composite measure (CXA), defined as the sum of XA against elbow, wrist, and extrinsic finger flexors (upper limb) or soleus and gastrocnemius muscles (lower limb). Active function was assessed by the Modified Frenchay Scale and 10-m comfortable barefoot walking speed in the upper limb and lower limb, respectively. Correlations between CXA and active function at Weeks 4 and 12 of open-label cycles were explored. RESULTS CXA and active function were moderately correlated in the upper limb (P < 0.0001-0.0004, r = 0.476-0.636) and weakly correlated in the lower limb (P < 0.0001-0.0284, r = 0.186-0.285) at Weeks 4 and 12 of each open-label cycle. Changes in CXA and active function were weakly correlated only in the upper limb (Cycle 2 Week 12, P = 0.0160, r = 0.213; Cycle 3 Week 4, P = 0.0031, r = 0.296). Across cycles, CXA improvements peaked at Week 4, while functional improvements peaked at Week 12. CONCLUSION CXA is a valid measure for functional impairments in spastic paresis. CXA improvements following abobotulinumtoxinA injection correlated with and preceded active functional improvements.
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Affiliation(s)
- Nicolas Bayle
- EA 7377 BIOTN, Service de Rééducation Neurolocomotrice, Université Paris-Est Créteil, Hospital Albert Chenevier-Henri Mondor, Créteil, France
| | | | | | | | - Jean-Michel Gracies
- EA 7377 BIOTN, Service de Rééducation Neurolocomotrice, Université Paris-Est Créteil, Hospital Albert Chenevier-Henri Mondor, Créteil, France
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Patel AT, Ashford S, Jacinto J, Fheodoroff K, Brashear A, Maisonobe P, Balcaitiene J, Turner-Stokes L. Poster 52: Botulinum Toxin A in Upper Limb Spasticity Management: Baseline Data from the Upper Limb International Spasticity (ULIS)-III Study. PM R 2018. [DOI: 10.1016/j.pmrj.2018.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rubin B, Ashford S, Jacinto J, Fheodoroff K, Maisonobe P, Balcaitiene J, Turner-Stokes L. Poster 55: Relief of Spasticity-Related Pain with Botulinum Neurotoxin-A (BoNT-A) in Real Life Practice. Post-Hoc Analysis from a Large International Cohort Series. PM R 2018. [DOI: 10.1016/j.pmrj.2018.08.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gracies J, Francisco G, Jech R, Boyer F, Balcaitiene J, Maisonobe P. Simultaneous upper and lower limb abobotulinumtoxinA injections and guided self-rehabilitation contracts in spastic hemiparesis: Baseline data from the engage study. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rosales R, Goh K, Kumthornthip W, Mazlan M, Abdul Latif L, De Los Santos M, Chotiyarnwong C, Tanvijit P, Balcaitiene J, Maisonobe P, Kong K. Effect of early use of abobotulinumtoxina on time to post-stroke spasticity progression: Results of the ontime pilot study. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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McAllister P, Khatkova S, Faux S, Picaut P, Balcaitiene J, Raymond R, Gracies J. Poster 64: AbobotulinumtoxinA Injections in the Upper and Lower Limb in Patients with Spastic Paresis and Impaired Function Following Stroke or Traumatic Brain Injury. PM R 2017. [DOI: 10.1016/j.pmrj.2017.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Peter McAllister
- New England Institute for Neurology and Headache, Stamford, CT, United States
| | - Svetlana Khatkova
- New England Institute for Neurology and Headache, Stamford, CT, United States
| | - Steven Faux
- New England Institute for Neurology and Headache, Stamford, CT, United States
| | - Philippe Picaut
- New England Institute for Neurology and Headache, Stamford, CT, United States
| | - Jovita Balcaitiene
- New England Institute for Neurology and Headache, Stamford, CT, United States
| | - Romain Raymond
- New England Institute for Neurology and Headache, Stamford, CT, United States
| | - Jean‐Michel Gracies
- New England Institute for Neurology and Headache, Stamford, CT, United States
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Gracies J, Francisco GE, Jech R, Boyer FC, Maisonobe P, Balcaitiene J. Poster 62: Effect on Voluntary Movements of Simultaneous Upper and Lower Limb AbobotulinumtoxinA Injections in Conjunction with Guided Self‐Rehabilitation Contracts in Adults with Spastic Hemiparesis: Methodology of the ENGAGE Study. PM R 2017. [DOI: 10.1016/j.pmrj.2017.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jean‐Michel Gracies
- EA 7377 BIOTN, Université Paris‐Est, Hospital Albert Chenevier‐Henri Mondor, Service de Rééducation Neurolocomotrice, Créteil, Créteil, France
| | - Gerard E. Francisco
- EA 7377 BIOTN, Université Paris‐Est, Hospital Albert Chenevier‐Henri Mondor, Service de Rééducation Neurolocomotrice, Créteil, Créteil, France
| | - Robert Jech
- EA 7377 BIOTN, Université Paris‐Est, Hospital Albert Chenevier‐Henri Mondor, Service de Rééducation Neurolocomotrice, Créteil, Créteil, France
| | - Francois Constant Boyer
- EA 7377 BIOTN, Université Paris‐Est, Hospital Albert Chenevier‐Henri Mondor, Service de Rééducation Neurolocomotrice, Créteil, Créteil, France
| | - Pascal Maisonobe
- EA 7377 BIOTN, Université Paris‐Est, Hospital Albert Chenevier‐Henri Mondor, Service de Rééducation Neurolocomotrice, Créteil, Créteil, France
| | - Jovita Balcaitiene
- EA 7377 BIOTN, Université Paris‐Est, Hospital Albert Chenevier‐Henri Mondor, Service de Rééducation Neurolocomotrice, Créteil, Créteil, France
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Perennou D, Turner-Stokes L, Balcaitiene J, Ashford S, Jacinto J, Maisonobe P, Fheodoroff K. Time to retreatment with botulinum toxin A in upper limb spasticity management: Initial data from the Upper Limb International Spasticity (ULIS)-III study. Ann Phys Rehabil Med 2017. [DOI: 10.1016/j.rehab.2017.07.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Balcaitiene J, Rosales R, Goh KJ, Kumthornthip W, Mazlan M, Latif LA, Santos MMDL, Chotiyarnwong C, Tanvijit P, Maisonobe P, Kong KH. Effect of early use of abobotulinumtoxinA (DYSPORT®) after stroke on spasticity progression: First results of a pilot study. Ann Phys Rehabil Med 2017. [DOI: 10.1016/j.rehab.2017.07.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kong KH, Balcaitiene J, Berard H, Maisonobe P, Goh KJ, Kumthornthip W, Rosales RL. Effect of early use of AbobotulinumtoxinA after stroke on spasticity progression: Protocol for a randomised controlled pilot study in adult subjects with moderate to severe upper limb spasticity (ONTIME pilot). Contemp Clin Trials Commun 2017; 6:9-16. [PMID: 29740633 PMCID: PMC5936745 DOI: 10.1016/j.conctc.2017.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/23/2017] [Accepted: 02/04/2017] [Indexed: 01/12/2023] Open
Abstract
Introduction Approximately 15 million people suffer a stroke annually, up to 40% of which may develop spasticity, which can result in impaired limb function, pain and associated involuntary movements affecting motor control. Robust clinical data on spasticity progression, associated symptoms development and functional impairment is scarce. Additionally, maximal duration of muscle tone reduction following botulinum toxin type A (BoNT-A) injections remains undetermined. The ONTIME pilot study aims to explore these issues and evaluate whether abobotulinumtoxinA 500 U (Dysport®; Ipsen) administered intramuscularly within 12 weeks following stroke delays the appearance or progression of symptomatic (disabling) upper limb spasticity (ULS). Methods ONTIME is a 28-week, phase 4, randomised, double-blind, placebo-controlled, exploratory pilot study initiated at four centres across Malaysia, the Philippines, Singapore and Thailand. Subjects (n = 42) with moderate to severe ULS (modified Ashworth scale [MAS] score ≥2) in elbow flexors or pronators, wrist flexors, or finger flexors will be recruited. Subjects will be randomised 2:1 to abobotulinumtoxinA 500 U or placebo (single dose 2–12 weeks after first-ever stroke). Primary efficacy will be measured by time between initial injection and visit at which reinjection criteria (MAS score ≥2 in the primary targeted muscle group and appearance or reappearance of symptomatic ULS) are met. Follow-up visits will be 4-weekly to a maximum of 28 weeks. Discussion This pilot study will facilitate the design and sample size calculation of further confirmatory studies, and is expected to provide insights into the optimal management of post-stroke patients, including timing of BoNT-A therapy and follow-up duration.
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Key Words
- ANCOVA, analysis of covariance
- AbobotulinumtoxinA
- BoNT-A
- Botulinum neurotoxin type A
- CI, confidence interval
- FU, follow-up
- IM, intramuscularly
- MAS, modified Ashworth scale
- MRS, modified Rankin scale
- Modified Ashworth scale
- NPRS, numeric pain rating scale
- Post-stroke
- RC, reinjection criteria
- ULS, upper limb spasticity
- Upper limb spasticity
- eCRF, electronic case report form
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Affiliation(s)
- Keng He Kong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433 Novena, Singapore
- Corresponding author. Tan Tock Seng Hospital, TTSH Rehabilitation Centre, 17 Ang Mo Kio Ave 9, 569 766, Singapore.
| | - Jovita Balcaitiene
- Medical Affairs, Ipsen Group, 65 Quai Georges Gorse, 92100 Boulogne-Billancourt, France
| | - Hugues Berard
- Medical Affairs, Ipsen Group, 65 Quai Georges Gorse, 92100 Boulogne-Billancourt, France
| | - Pascal Maisonobe
- Medical Affairs, Ipsen Group, 65 Quai Georges Gorse, 92100 Boulogne-Billancourt, France
| | - Khean Jin Goh
- Division of Neurology, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Witsanu Kumthornthip
- Department of Rehabilitation Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Raymond L. Rosales
- Centre for Neurodiagnostic and Therapeutic Services (CNS), Metropolitan Medical Centre, Philippines
- Department of Neurology & Psychiatry, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
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Khatkova S, Balcaitiene J, Jacinto J, Fheodoroff K, Ashford S, Maisonobe P, Turner-Stokes L. A comparison of goal selection and achievement according to patient sex in the upper limb international spasticity (ULIS)-Ii study. Toxicon 2016. [DOI: 10.1016/j.toxicon.2016.11.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Turner-Stokes L, Balcaitiene J, Ashford S, Jacinto J, Maisonobe P, Fheodoroff K. Integrated upper limb spasticity management including botulinum toxin A (BoNT-A) on patient-centred goal attainment: Methodology for ULIS-III and initial goal-setting data. Toxicon 2016. [DOI: 10.1016/j.toxicon.2016.11.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rosales RL, Goh KJ, Kumthornthip W, Balcaitiene J, Maisonobe P, Kong KH. Baseline characteristics of patients from a pilot study to assess the effect of early use of abobotulinumtoxinA (Dysport®) after stroke on spasticity progression. Toxicon 2016. [DOI: 10.1016/j.toxicon.2016.11.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Jacinto J, Balcaitiene J, Maisonobe P, Fheodoroff K, Ashford S, Turner-Stokes L. Relationship between abobotulinumtoxina injections into shoulder muscles and patient-centered primary goal selection and achievement: Subanalyses from the upper limb international spasticity (ULIS)-II study. Toxicon 2016. [DOI: 10.1016/j.toxicon.2016.11.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Turner‐Stokes L, Balcaitiene J, Ashford S, Jacinto J, Maisonobe P, Fheodoroff K. Poster 373‐C Integrated Upper Limb Spasticity Management Including Botulinum Toxin A (BoNT‐A) on Patient‐Centered Goal Attainment: Methodology for ULIS‐III and Initial Goal‐Setting Data. PM R 2016; 8:S331. [DOI: 10.1016/j.pmrj.2016.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lynne Turner‐Stokes
- King's College London School of Medicine, Palliative Care, Policy and Rehabilitation and Regional Rehabilitation Unit, Northwick Park Hospital, London, UK
| | - Jovita Balcaitiene
- King's College London School of Medicine, Palliative Care, Policy and Rehabilitation and Regional Rehabilitation Unit, Northwick Park Hospital, London, UK
| | - Stephen Ashford
- King's College London School of Medicine, Palliative Care, Policy and Rehabilitation and Regional Rehabilitation Unit, Northwick Park Hospital, London, UK
| | - Jorge Jacinto
- King's College London School of Medicine, Palliative Care, Policy and Rehabilitation and Regional Rehabilitation Unit, Northwick Park Hospital, London, UK
| | - Pascal Maisonobe
- King's College London School of Medicine, Palliative Care, Policy and Rehabilitation and Regional Rehabilitation Unit, Northwick Park Hospital, London, UK
| | - Klemens Fheodoroff
- King's College London School of Medicine, Palliative Care, Policy and Rehabilitation and Regional Rehabilitation Unit, Northwick Park Hospital, London, UK
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Abstract
PURPOSE To better understand patient perspectives on the life impact of spasticity. METHODS Global Internet survey (April 2014-May 2015) of 281 people living with spasticity. RESULTS Respondents indicated that spasticity has a broad impact on their daily-life: 72% reported impact on quality of life, 44% reported loss of independence and 44% reported depression. Most respondents (64%) were cared for by family members, of whom half had stopped working or reduced their hours. Overall, 45% reported dissatisfaction with the information provided at diagnosis; main reasons were "not enough information" (67%) and "technical terminology" (36%). Respondents had high treatment expectations; 63% expected to be free of muscle spasm, 41% to take care of themselves and 36% to return to a normal routine. However, 33% of respondents had not discussed these expectations with their physician. The most common treatments were physiotherapy (75%), botulinum neurotoxin (BoNT, 73%) and oral spasmolytics (57%). Of those treated with BoNT, 47% waited >1 year from spasticity onset to treatment. CONCLUSIONS This survey emphasises the broad impact of spasticity and highlights unmet needs in the patient journey. Improvements with regards to communication and the therapeutic relationship would be especially welcomed by patients, and would help manage treatment expectations. Implications of Rehabilitation Spasticity has broad impact on the lives of patients and their families that extends beyond the direct physical disability. Patients with spasticity need to be well informed about their condition and treatments available and should be given the opportunity to discuss their expectations. Physicians need to be aware of the patient's individual needs and expectations in order to better help them achieve their therapeutic goals.
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Affiliation(s)
| | - Serdar Kocer
- b Centre de Rééducation de l'Hôpital du Jura , Porrentruy , Switzerland
| | | | | | - Klemens Fheodoroff
- e Department of Neurorehabilitation , Gailtal-Klinik , Hermagor , Austria
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Turner-Stokes L, Ashford S, Jacinto J, Maisonobe P, Balcaitiene J, Fheodoroff K. Impact of integrated upper limb spasticity management including botulinum toxin A on patient-centred goal attainment: rationale and protocol for an international prospective, longitudinal cohort study (ULIS-III). BMJ Open 2016; 6:e011157. [PMID: 27315835 PMCID: PMC4916608 DOI: 10.1136/bmjopen-2016-011157] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Describe the rationale and protocol for the Upper Limb International Spasticity (ULIS)-III study, which aims to evaluate the impact of integrated spasticity management, involving multiple botulinum toxin A (BoNT-A) injection cycles and concomitant therapies, on patient-centred goal attainment. Outline novel outcome assessment methods for ULIS-III and report initial evaluation data from goal setting in early stages of the study. DESIGN Large international longitudinal cohort study of integrated upper limb spasticity management, including BoNT-A. PARTICIPANTS AND SETTING ULIS-III is a 2-year study expected to enrol >1000 participants at 58 study centres across 14 countries. INTERVENTIONS The study design is non-interventional and intended to reflect real-life clinical practice. It will describe injection practices and additional treatment strategies, and record clinical decision-making in a serial approach to long-term spasticity management. OUTCOME MEASURES ULIS-III will use a goal-directed approach to selection of targeted standardised measures to capture the diversity of presentation, goals and outcomes. ULIS-III will implement the Upper Limb Spasticity Index, a battery of assessments including a structured approach to goal attainment scaling (Goal Attainment Scaling-Evaluation of Outcomes for Upper Limb Spasticity tool), alongside a limited set of standardised measures, chosen according to patients' selected goal areas. Concomitant therapy inputs, patient satisfaction with engagement in goal setting, health economic end points and health-related quality of life data will also be captured. RESULTS OF INITIAL EVALUATION OF GOAL QUALITY Recruitment started in January 2015. By June 2015, 58 sites had been identified and initial data collected for 79 patients across 13 sites in 3 countries. Goal setting data were quality-checked and centres rated on the basis of function-related and Specific, Measurable, Achievable, Realistic, Timed (SMART) characteristics of goal statements. Overall, 11/13 centres achieved the highest rating (A++). CONCLUSIONS ULIS-III will provide valuable information regarding treatment of and outcomes from real-life upper limb spasticity management worldwide. TRIAL REGISTRATION NUMBER NCT02454803; Pre-results.
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Affiliation(s)
- Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation and Regional Rehabilitation Unit, King's College London School of Medicine, Northwick Park Hospital, London, UK
| | - Stephen Ashford
- Department of Palliative Care, Policy and Rehabilitation and Regional Rehabilitation Unit, King's College London School of Medicine, Northwick Park Hospital, London, UK
| | - Jorge Jacinto
- Centro de Medicina de Reabilitaçãode Alcoitão, Serviço de Reabilitação de Adultos, Estoril, Portugal
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Bowers D, Khan P, Dashtipour K, Bahroo L, Lee MY, Balcaitiene J, Evidente V. Poster 27 Analyzing the Patient Journey for Patients Living with Spastic Paresis. PM R 2015. [DOI: 10.1016/j.pmrj.2015.06.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fheodoroff K, Ashford S, Jacinto J, Maisonobe P, Balcaitiene J, Turner-Stokes L. Factors influencing goal attainment in patients with post-stroke upper limb spasticity following treatment with botulinum toxin A in real-life clinical practice: sub-analyses from the Upper Limb International Spasticity (ULIS)-II Study. Toxins (Basel) 2015; 7:1192-205. [PMID: 25856546 PMCID: PMC4417963 DOI: 10.3390/toxins7041192] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/16/2015] [Accepted: 03/26/2015] [Indexed: 11/16/2022] Open
Abstract
In this post-hoc analysis of the ULIS-II study, we investigated factors influencing person-centred goal setting and achievement following botulinum toxin-A (BoNT-A) treatment in 456 adults with post-stroke upper limb spasticity (ULS). Patients with primary goals categorised as passive function had greater motor impairment (p < 0.001), contractures (soft tissue shortening [STS]) (p = 0.006) and spasticity (p = 0.02) than those setting other goal types. Patients with goals categorised as active function had less motor impairment (0.0001), contracture (p < 0.0001), spasticity (p < 0.001) and shorter time since stroke (p = 0.001). Patients setting goals for pain were older (p = 0.01) with more contractures (p = 0.008). The proportion of patients achieving their primary goal was not impacted by timing of first-ever BoNT-A injection (medium-term (≤1 year) vs. longer-term (>1 year)) post-stroke (80.0% vs. 79.2%) or presence or absence of severe contractures (76.7% vs. 80.6%), although goal types differed. Earlier BoNT-A intervention was associated with greater achievement of active function goals. Severe contractures impacted negatively on goal achievement except in pain and passive function. Goal setting by patients with ULS is influenced by impairment severity, age and time since stroke. Our findings resonate with clinical experience and may assist patients and clinicians in selecting realistic, achievable goals for treatment.
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Affiliation(s)
- Klemens Fheodoroff
- Department of Neurorehabilitation, Gailtal-Klinik, Hermagor 9620, Austria.
| | - Stephen Ashford
- Faculty of Life Sciences and Medicine Faculty of Life Sciences and Medicine, Department of Palliative Care, Policy and Rehabilitation, King's College London, London SE5 9PJ, UK.
- Regional Rehabilitation Unit, Northwick Park Hospital, London HA1 3UJ, UK.
| | - Jorge Jacinto
- Adult Rehabilitation Department 3, Alcoitão Medical Rehabilitation Centre, Estoril 2649 506, Portugal.
| | - Pascal Maisonobe
- Medical Affairs, Ipsen Pharma, Boulogne-Billancourt 92650, France.
| | | | - Lynne Turner-Stokes
- Faculty of Life Sciences and Medicine Faculty of Life Sciences and Medicine, Department of Palliative Care, Policy and Rehabilitation, King's College London, London SE5 9PJ, UK.
- Regional Rehabilitation Unit, Northwick Park Hospital, London HA1 3UJ, UK.
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El-Fegoun YB, Balcaitiene J, Rink C. 71. Average dose of botulinum neurotoxin A (BoNT/A) injected into patients in real life (physician’s practice). Toxicon 2015. [DOI: 10.1016/j.toxicon.2014.11.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Dinet J, Lambrelli D, Balcaitiene J. Economic Modeling of The Use of Botulinum Toxin A in A Homogenous Patient Population Based on Real-Life Clinical Practice: Ulis-Ii (The Upper Limb International Spasticity Study). Value Health 2014; 17:A377. [PMID: 27200825 DOI: 10.1016/j.jval.2014.08.2596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J Dinet
- IPSEN Pharma, Boulogne-Billancourt, France
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