{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T23:23:37Z","timestamp":1793229817335,"version":"4.5.0"},"reference-count":64,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2020,2,27]],"date-time":"2020-02-27T00:00:00Z","timestamp":1582761600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007819","name":"Allergan","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007819","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>OnabotulinumtoxinA treatment for spasticity is dependent on numerous factors and varies according to selected treatment goals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine real\u2010world onabotulinumtoxinA treatment utilization and effectiveness in patients with upper limb spasticity over 2\u2009years from the Adult Spasticity International Registry (ASPIRE) study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Multicenter, prospective, observational registry (NCT01930786).<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Fifty\u2010four international clinical sites in North America, Europe, and Asia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>Adults (na\u00efve or non\u2010na\u00efve to botulinum toxins for spasticity) with upper limb focal spasticity related to upper motor neuron syndrome across multiple etiologies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>OnabotulinumtoxinA administered at clinician's discretion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>OnabotulinumtoxinA utilization, clinician and patient satisfaction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Four hundred eighty\u2010four patients received \u22651 treatment of onabotulinumtoxinA for upper limb spasticity. Patients were on average 55.1\u2009years old, 50.8% male, predominantly Caucasian (72.3%), and 38.6% were na\u00efve to botulinum toxins. Stroke was the most frequently reported underlying etiology (74.0%). Most patients (81.2%) had moderate to severe spasticity at baseline. The most commonly treated upper limb clinical presentation was clenched fist (79.1% of patients). Across all presentations, onabotulinumtoxinA doses ranged between 5\u2010600U. Electromyography (EMG) was most often utilized to localize muscles (\u226557.0% of treatment sessions). Clinicians (92.9% of treatment sessions) and patients (85.7%) reported being extremely satisfied\/satisfied that treatment helped manage spasticity, and clinicians (98.6%) and patients (92.2%) would definitely\/probably continue onabotulinumtoxinA treatment. One hundred seventy\u2010nine patients (37.0%) reported 563 adverse events (AEs); 15 AEs in 14 patients (2.9%) were considered treatment related. Sixty\u2010nine patients (14.3%) reported 137 serious AEs; 3 serious AEs in 2 patients (0.4%) were considered treatment related. No new safety signals were identified.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>ASPIRE captured the real\u2010world individualized nature of onabotulinumtoxinA utilization for upper limb spasticity over 2\u2009years, with consistently high clinician\u2010 and patient\u2010reported satisfaction. Data in this primary analysis will guide clinical use of onabotulinumtoxinA, as well as provide insights to improve educational programs on spasticity management.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pmrj.12328","type":"journal-article","created":{"date-parts":[[2020,1,18]],"date-time":"2020-01-18T02:51:00Z","timestamp":1579315860000},"page":"1120-1133","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Individualized OnabotulinumtoxinA Treatment for Upper Limb Spasticity Resulted in High Clinician\u2010 and Patient\u2010Reported Satisfaction: Long\u2010Term Observational Results from the ASPIRE Study"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5681-1916","authenticated-orcid":false,"given":"Gerard E.","family":"Francisco","sequence":"first","affiliation":[{"name":"The University of Texas Health Science Center McGovern Medical School and TIRR Memorial Hermann  Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang H.","family":"Jost","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Freiburg  Freiburg im Breisgau Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganesh","family":"Bavikatte","sequence":"additional","affiliation":[{"name":"The Walton Centre  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel S.","family":"Bandari","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Center of California &amp; Research Group  Newport Beach CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon F.T.","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation Lotung Poh\u2010Ai Hospital  Yilan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Munin","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation University of Pittsburgh School of Medicine  Pittsburgh PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Largent","sequence":"additional","affiliation":[{"name":"IQVIA Real\u2010World Evidence Solutions  Cambridge MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aubrey M.","family":"Adams","sequence":"additional","affiliation":[{"name":"Allergan plc  Irvine CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksej","family":"Zuzek","sequence":"additional","affiliation":[{"name":"Allergan plc  Irvine CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0698-6424","authenticated-orcid":false,"given":"Alberto","family":"Esquenazi","sequence":"additional","affiliation":[{"name":"MossRehab Gait and Motion Analysis Laboratory  Elkins Park PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,2,27]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/09638280400014576"},{"issue":"2","key":"e_1_2_7_3_1","first-page":"143","article-title":"Research on a technic for measurement of spasticity","volume":"91","author":"Tardieu G","year":"1954","journal-title":"Rev Neurol (Paris)"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-018-8759-1"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2011-000155"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g4737"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2010.03129.x"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/354906"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxicon.2012.11.025"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PHM.0000141127.63160.3E"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/ane.12139"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/HTR.0000000000000234"},{"key":"e_1_2_7_13_1","first-page":"1793","article-title":"Caregiver burden, productivity loss, and indirect costs associated with caring for patients with poststroke spasticity","volume":"10","author":"Ganapathy V","year":"2015","journal-title":"Clin Interv Aging"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.558619"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000141977.18520.3b"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.3109\/02699052.2013.804202"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00702-007-0833-2"},{"key":"e_1_2_7_18_1","volume-title":"Management Using Botulinum Toxin","author":"Physicians RCo. 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