Objective: To present expert consensus on choice of outcome measurement scales and goal setting recommendations for botulinum neurotoxin (BoNT) in the treatment of shoulder spasticity to increase awareness of shoulder muscle injection with BoNT, alongside other more commonly injected upper limb muscles.

Background: BoNT is a first line treatment option for post-stroke spasticity, reducing pain and involuntary movements and helping to restore function. Recent clinical trials have reported improvements in pain and function after shoulder muscle BoNT injections.

Method: Expert consensus was obtained after a two-part meeting held online in late 2021. Five European experts with a cumulative experience of ~100 years in poststroke spasticity gave presentations on shoulder spasticity and multi-pattern treatment with BoNT injections followed by discussion. In addition, a pre-meeting survey was conducted to capture information on preferred treatment practices.

Results: Although velocity-dependent increase in muscle tone is often a focus of patient assessment, it is only one component of spasticity and should be assessed as part of a wider range of measurements. For outcome measurement following BoNT injection in shoulder muscles, shoulder-specific scales are recommended: Ashworth Scale Shoulder SumScore (AS-SSS), Spasticity-Associated Arm Pain Scale (SAAPS) and shoulder-relevant items of the Arm Activity measure (ArmA), plus standard measurements. Other scales to be considered include Pain Numerical Rating and/or global functioning, as well as quality of life and global perception of benefit scores.
Goal setting is an essential part of the multiprofessional management process for spasticity; goals should be patient-centric, realistic and achievable; functional-focused goal statements and a mixture of short (3-6 month) and long-term (9-18 month) goals are recommended. Goals can be grouped into symptomatic, passive function, active function, involuntary movement and global mobility, measured with the Goal Attainment Scale.

Conclusion: Clinical evaluation tools, goal setting and outcome expectations for the multipattern treatment of shoulder spasticity with BoNT should be defined by the whole multiprofessional team, ensuring patient and caregiver involvement. These recommendations will benefit clinicians who may not be familiar with injecting shoulder muscles and assessment of treatment outcomes.

« Back to 2022 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/outcome-measurement-and-goal-setting-recommendations-in-the-multipattern-treatment-of-shoulder-spasticity-with-botulinum-neurotoxin/