{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:34:46Z","timestamp":1791862486521,"version":"4.3.4"},"reference-count":22,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JRM"],"abstract":"<jats:p>Objective: This post-hoc analysis evaluated how goal attainment evolved over repeated cycles of botulinum toxin A (BoNT-A) treatment in adults with upper-limb spasticity.\nMethods: ULIS-III (NCT02454803) was a 2-year observational study involving adults treated with BoNT-A. The analysis included 538 patients who received \u2265\u20094 BoNT-A injection cycles and had Goal Attainment Scaling (GAS) assessments for each of the first 4 cycles. GAS T-scores were used to measure treatment response. Multivariate models assessed predictors of achieving a GAS T-score \u2265\u200950 and being in the top tertile (best) of responders.\nResults: Patients generally maintained consistent goal domains across cycles. Mean change in GAS T-scores remained above the minimal clinically important difference of 10 throughout. The proportion of patients achieving a GAS T-score \u2265\u200950 increased from 64.5% in Cycle 1 to 75.8% in Cycle\u00a04. Use of injection guidance techniques significantly increased the odds of achieving treatment goals (OR 1.92; 95% CI 1.45\u20132.55) and being a \u201cbest\u201d responder (OR 2.44; 95% CI 1.47\u20134.06). Higher BoNT-A doses were also associated with better outcomes.\nConclusions: Repeated BoNT-A treatment supports sustained goal attainment in upper limb spasticity. Success rates improve with each cycle, particularly when guided injection techniques are used.<\/jats:p>","DOI":"10.2340\/jrm.v58.45139","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T13:03:17Z","timestamp":1777381397000},"page":"jrm45139","source":"Crossref","is-referenced-by-count":1,"title":["Evolution of goal setting and attainment over repeated cycles of botulinum toxin A for upper limb spasticity in real-life clinical practice: longitudinal analyses from the observational ULIS-III cohort study"],"prefix":"10.2340","volume":"58","author":[{"given":"Lynne","family":"Turner-Stokes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klemens","family":"Fheodoroff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Jacinto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Beneteau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Maisonobe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Hannes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Ashford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"153336","doi-asserted-by":"crossref","unstructured":"Gracies JM, Brashear A, Jech R, McAllister P, Banach M, Valkovic P, et al. Safety and efficacy of abobotulinumtoxinA for hemiparesis in adults with upper limb spasticity after stroke or traumatic brain injury: a double-blind randomised controlled trial. Lancet Neurol 2015; 14: 992\u20131001.","DOI":"10.1016\/S1474-4422(15)00216-1"},{"key":"153337","doi-asserted-by":"crossref","unstructured":"Elovic EP, Munin MC, Kanovsky P, Hanschmann A, Hiersemenzel R, Marciniak C. Randomized, placebo-controlled trial of incobotulinumtoxina for upper-limb post-stroke spasticity. Muscle Nerve 2016; 53: 415\u2013421.","DOI":"10.1002\/mus.24776"},{"key":"153338","doi-asserted-by":"crossref","unstructured":"Simpson DM, Gracies JM, Yablon SA, Barbano R, Brashear A, Bo NTTZDST. Botulinum neurotoxin versus tizanidine in upper limb spasticity: a placebo-controlled study. J Neurol Neurosurg Psychiatry 2009; 80: 380\u2013385.","DOI":"10.1136\/jnnp.2008.159657"},{"key":"153339","unstructured":"Royal College of Physicians (UK). Spasticity in adults: management using botulinum toxin. 2018. Available from: https:\/\/www.rcplondon.ac.uk\/guidelines-policy\/spasticity-adults-management-using-botulinum-toxin"},{"key":"153340","doi-asserted-by":"crossref","unstructured":"Francisco GE, Balbert A, Bavikatte G, Bensmail D, Carda S, Deltombe T, et al. A practical guide to optimizing the benefits of post-stroke spasticity interventions with botulinum toxin A: an international group consensus. J Rehabil Med 2021; 53: jrm00134.","DOI":"10.2340\/16501977-2753"},{"key":"153341","doi-asserted-by":"crossref","unstructured":"Reebye R, Balbert A, Bensmail D, Walker H, Wissel J, Deltombe T, et al. Module 2: Nonsurgical management of spasticity. Arch ISPRM 2022; 5: S23\u2013S37.","DOI":"10.4103\/2349-7904.347808"},{"key":"153342","doi-asserted-by":"crossref","unstructured":"Ashford S, Slade M, Malaprade F, Turner-Stokes L. Evaluation of functional outcome measures for the hemiparetic upper limb: a systematic review. J Rehabil Med 2008; 40: 787\u2013795.","DOI":"10.2340\/16501977-0276"},{"key":"153343","doi-asserted-by":"crossref","unstructured":"Ashford S, Turner-Stokes L. Systematic review of upper-limb function measurement methods in botulinum toxin intervention for focal spasticity. Physiother Res Int 2013; 18: 178\u2013189.","DOI":"10.1002\/pri.1554"},{"key":"153344","doi-asserted-by":"crossref","unstructured":"Sunnerhagen KS, Olver J, Francisco GE. Assessing and treating functional impairment in poststroke spasticity. Neurology 2013; 80: S35\u201344.","DOI":"10.1212\/WNL.0b013e3182764aa2"},{"key":"153345","doi-asserted-by":"crossref","unstructured":"Turner-Stokes L, Fheodoroff K, Jacinto J, Maisonobe P, Ashford S. ULIS (Upper Limb International Spasticity), a 10-year Odyssey: an international, multicentric, longitudinal cohort of person-centered spasticity management in real-life practice. Arch ISPRM 2019; 2: 138\u2013150.","DOI":"10.4103\/jisprm.jisprm_47_19"},{"key":"153346","doi-asserted-by":"crossref","unstructured":"Kiresuk TJ, Sherman RE. Goal attainment scaling: a general method for evaluating comprehensive community mental health programs. Community Ment Health J 1968; 4: 443\u2013453.","DOI":"10.1007\/BF01530764"},{"key":"153347","doi-asserted-by":"crossref","unstructured":"Krasny-Pacini A, Hiebel J, Pauly F, Godon S, Chevignard M. Goal attainment scaling in rehabilitation: a literature-based update. Ann Phys Rehabil Med 2013; 56: 212\u2013230.","DOI":"10.1016\/j.rehab.2013.02.002"},{"key":"153348","doi-asserted-by":"crossref","unstructured":"Turner-Stokes L, Jacinto J, Fheodoroff K, Brashear A, Maisonobe P, Lysandropoulos A, et al. Longitudinal goal attainment with integrated upper limb spasticity management including repeat injections of botulinum toxin A: findings from the prospective, observational Upper Limb International Spasticity (ULIS-III) cohort study. J Rehabil Med 2021; 53: jrm00157.","DOI":"10.2340\/16501977-2801"},{"key":"153349","doi-asserted-by":"crossref","unstructured":"Fheodoroff K, Jacinto J, Ashford S, Danchenko N, Grandoulier A-S, Pietri G, et al. Predictors of real-world response in adults treated with botulinumtoxin-A for upper limb spasticity. Arch ISPRM 2024; 7: 24\u201332.","DOI":"10.1097\/ph9.0000000000000030"},{"key":"153350","doi-asserted-by":"crossref","unstructured":"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). 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Longitudinal, multi-cycle evaluation of passive function improvement in people with arm spasticity treated with botulinum toxin A. Toxins 2026; 18: 51.","DOI":"10.3390\/toxins18010051"},{"key":"153355","doi-asserted-by":"crossref","unstructured":"Esquenazi A, Zorowitz RD, Ashford S, Beneteau M Maisonobe P, Hannes C, et al. Longitudinal goal attainment with repeat injections of abobotulinumtoxina in adults with lower limb spasticity: results from a prospective observational study. Arch Phys Med Rehabil 2025; 106: 894\u2013901.","DOI":"10.1016\/j.apmr.2024.10.017"},{"key":"153356","doi-asserted-by":"crossref","unstructured":"Asimakidou E, Sidiropoulos C. A Bayesian network meta-analysis and systematic review of guidance techniques in botulinum toxin injections and their hierarchy in the treatment of limb spasticity. Toxins 2023; 15: 256.","DOI":"10.3390\/toxins15040256"},{"key":"153357","doi-asserted-by":"crossref","unstructured":"Luk E, Baguley IJ, Olver J, Nunan R, Estell J, Gonzalez S, et al. Goal attainment with integrated upper limb spasticity management including botulinum toxin-A (BoNT-A): subanalysis of Australian data from the ULIS-III study. Arch ISPRM 2023; 6: 83\u201389.","DOI":"10.1097\/ph9.0000000000000024"}],"container-title":["Journal of Rehabilitation Medicine"],"original-title":[],"link":[{"URL":"https:\/\/medicaljournalssweden.se\/jrm\/article\/download\/45139\/53695","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/medicaljournalssweden.se\/jrm\/article\/download\/45139\/53697","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/medicaljournalssweden.se\/jrm\/article\/download\/45139\/53695","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T13:03:33Z","timestamp":1777381413000},"score":1,"resource":{"primary":{"URL":"https:\/\/medicaljournalssweden.se\/jrm\/article\/view\/45139"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":22,"URL":"https:\/\/doi.org\/10.2340\/jrm.v58.45139","relation":{},"ISSN":["1651-2081"],"issn-type":[{"value":"1651-2081","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,28]]}}}