Goal Attainment Scaling in Individuals with Upper Limb Spasticity Post Stroke

Focusing on rehabilitation goals is an effective approach for improving function in individuals with spasticity after stroke. The objectives of this study were to examine and map goals of post-stroke individuals with spasticity using the Goal Attainment Scale (GAS) and International Classification of Functioning, Disability and Health (ICF), and to evaluate the impact of botulinum toxin A (BoNTA) on occupational performance based on the type of rehabilitation goals. Thirty-one patients were recruited from an outpatient spasticity management clinic. Each patient set one goal, was injected with BoNTA in their spastic upper limb muscles and received standard rehabilitation services twice a week for four weeks. Twenty-seven participants achieved the expected level, and four exceeded the expected level of their rehabilitation goals. Fifty-five percent of the goals were related to Activity/Participation, and 45% of the goals were categorized in the Body Structures and Function domain of the ICF. Fifteen goals focused on positioning, while 16 goals focused on (independent) activities of daily living (ADL/IADL). Both the positioning and ADL/IADL groups experienced a reduction in MAS following the administration of BoNTA. The positioning group was older and more impaired. Mapping goals to ICF identifies specific targets for intervention, establishes a common language within the interdisciplinary team and contextualizes the ways disability impacts goals. This study is limited by a relatively small sample size and absence of a functional measure. Further studies can explore the development of goal/item banks to advance the use of GAS for spasticity management. Copyright © 2016 John Wiley & Sons, Ltd.