Goal attainment with integrated upper limb spasticity management including botulinum toxin-A (BoNT-A): Subanalysis of Australian data from the ULIS-III study

Primary results from the international upper limb international spasticity-III study provided robust evidence for the benefit of repeated cycles of botulinum toxin-A (BoNT-A) for upper limb spasticity. Internationally, patients with active function goals tended to require more frequent injections, and we hypothesized that reimbursement restrictions in Australia (which typically limited the number of injections received) may have adversely impacted outcomes compared with the international cohort. Upper Limb International Spasticity-III was a prospective, observational study following adults living with spasticity over 2 years of goal-directed upper limb spasticity management including repeated BoNT-A treatment. The Australian subgroup included 115 patients (mean±SD age 53.8±16.9 years, 56% male, 79% stroke etiology), of whom 74% had previously been treated with BoNT-A. Australian participants had fewer injection cycles [2.7 (2.3, 3.0) vs. 4.1 (4.0, 4.3)] with longer injection intervals [330.6 (280.3, 381.0) vs. 200.3 (189.4, 211.1) days] than the international cohort. Across each evaluation cycle, patients in the Australian subgroup showed a change from baseline in Goal Attainment Scaling (GAS) T scores of >10, confirming relevant improvement. At 2 years, cumulated GAS T scores were 47.9 (46.4, 49.4) for the Australian subgroup versus 49.7 (49.3, 50.1) in the international cohort. Active function goals were generally underachieved in the Australian subgroup (mean cumulated GAS-T-score 43.6 (41.6, 45.6) vs. 47.4 (46.5, 48.3) internationally]. As anticipated, the Australian cohort had fewer injection cycles with longer intervals than seen internationally. Their overall goal attainment was lower than for the total cohort, which appeared to be driven by less active function goal attainment. Among other possible factors, these data support the idea that restricted reimbursement may have impacted BoNT-A injection frequency and consequently, patient outcomes.