Goal-Setting in Multiple Sclerosis-Related Spasticity Treated with Botulinum Toxin: The GASEPTOX Study
Abstract
:1. Introduction
2. Results
2.1. Patient Characteristics
2.2. Description of Goal-Setting
2.3. Goals Distribution by Lower or Upper Limb
2.4. Goals Description According to Descriptive Data
2.5. BoNT-A Efficacy and Goal Attainment
2.6. Pre-Post Spasticity Assessment (MAS)
3. Discussion
4. Conclusions
5. Future Perspectives
6. Methods
6.1. Study Design and Setting
6.2. Study Population
6.3. Defining Therapeutic Goals
6.4. Botulinum Toxin Injections and Follow-Up
6.5. Data Collection
6.6. Statistical Analysis
6.7. Ethics
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
BoNT-A | botulinum neurotoxin type A |
BTI | botulinum toxin injection |
EDSS | expanded disability status scale |
ICF | international classification of function |
GAS | goal attainment scaling |
IQ | interquartile |
LL | lower limb |
MAS | modified Ashworth scale |
MR004 | méthodologie de référence 004 |
MS | multiple sclerosis |
PP | primary progressive |
RR | relapsing remitting |
SD | standard deviation |
SMART | specific, measurable, achievable, relevant, timed |
SP | secondary progressive |
UL | upper limb |
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General | Center 1 | Center 2 | ||
---|---|---|---|---|
N | 125 | 81 | 44 | |
Sex | 36 male 85 female | 25 male 52 female | 11 male 33 female | |
Age (year) | Mean ± SD | 54.9 ± 11.1 | 56.0 ± 10.4 | 53.0 ± 12.0 |
Disease evolution (year) | Mean ± SD | 18.8 ± 9.7 | 18.8 ± 9.6 | 19 ±10.1 |
EDSS | median | 6 | 6 | 6 |
IQ | [4; 6.5] | [4.5; 6.5] | [3; 7] | |
MS phenotype | SP: 73 PP: 22 RR: 30 | SP: 51 PP: 15 RR: 15 | SP: 22 PP: 7 RR: 15 |
Goals | Percentage |
---|---|
Reduce the clinging of the ground | 9.87% |
Improve stability during ground support | 9.87% |
Reduce a toe claw to ease gait | 7.73% |
Reduce an equinus disturbing gait | 6.67% |
Improve walking perimeter | 4.00% |
Reduce a knee recurvatum in the support phase | 3.47% |
Other LL | 3.20% |
Improve balance | 2.93% |
Reduce a disturbing dystonia in hallux extension | 2.40% |
Reduce an equinus varus disturbing gait | 2.40% |
Prevent or limit retractions | 1.87% |
Improve walking speed | 1.87% |
Facilitate transfers | 1.87% |
Reduce spontaneous pain or mobilization pain | 1.60% |
Reduce knee flessum | 1.60% |
Reduce painful toe claw | 1.33% |
Facilitate the positioning of the feet on the wheelchair pallets | 1.07% |
Reduce a hip adductum disturbing the toilet, the dressing… | 1.07% |
Prevent or limit retractions | 1.07% |
Reduce spontaneous or mobilization pain | 1.07% |
Facilitate shoulder abduction | 0.80% |
Facilitate the use of the hand as an auxiliary hand | 0.80% |
Improve knee flexion in the oscillating phase | 0.80% |
Other UL | 0.80% |
Facilitate the passive opening of the hand | 0.53% |
Facilitate dressing, hygiene, nursing | 0.53% |
Reduce a disturbing attitude of the upper limb when walking or in other situations | 0.53% |
Reduce a hip adductum disturbing gait | 0.53% |
Facilitate the active opening of the hand to improve prehension | 0.27% |
Reduce hand maceration | 0.27% |
Reduce access to walking aids | 0.27% |
Facilitate knee flexion in various situations such as sitting in the wheelchair | 0.27% |
Facilitate shoeing | 0.27% |
Facilitate the use of the hand in other activities (computer keyboard, tablets…) | 0.00% |
Facilitate the wearing of a resting orthosis | 0.00% |
Facilitate access to the perineum (probes, sexuality, toilet, hygiene…) | 0.00% |
GAS Goal 1 Percentage | GAS Goal 2 Percentage | GAS Goal 3 Percentage | |
---|---|---|---|
Facilitate shoulder abduction | 1.6% | 0.8% | |
Facilitate the active opening of the hand to improve prehension | 0.8% | ||
Facilitate the use of the hand in other activities (computer keyboard, tablets…) | |||
Facilitating the use of the hand as an auxiliary hand | 0.8% | 1.6% | |
Facilitate the passive opening of the hand | 1.6% | ||
Reduce hand maceration | 0.8% | ||
Prevent or limit retractions | 2.4% | 2.4% | 0.8% |
Facilitate the wearing of a resting orthosis | |||
Facilitate dressing, hygiene, nursing | 0.8% | 0.8% | |
Reduce spontaneous or mobilization pain | 1.6% | 1.6% | 1.6% |
Reduce a disturbing attitude of the upper limb when walking or in other situations | 0.8% | 0.8% | |
Reduce the clinging of the ground | 18.4% | 8.8% | 2.4% |
To improve balance | 2.4% | 4.8% | 1.6% |
To improve stability during ground support | 16.8% | 10.4% | 2.4% |
Improve walking speed | 2.4% | 1.6% | 1.6% |
Improve walking perimeter | 8.0% | 2.4% | 1.6% |
Reduce access to walking aids | 0.8% | ||
Reduce a toe claw to ease gait | 5.6% | 4.0% | 13.6% |
Reduce painful toe claw | 1.6% | 0.8% | 1.6% |
Reduce a disturbing dystonia in extension of the hallux | 3.2% | 1.6% | 2.4% |
Reduce an equinus disturbing gait | 8.0% | 9.6% | 2.4% |
Reduce an equinus varus disturbing gait | 2.4% | 3.2% | 1.6% |
Facilitate the positioning of the feet on the wheelchair pallets | 1.6% | 1.6% | |
Reduce a hip adductum disturbing gait | 1.6% | ||
Reduce a hip adductum disturbing the toilet, dressing… | 2.4% | 0.8% | |
Facilitate access to the perineum (probes, sexuality, toilet, hygiene…) | |||
Reduce a knee recurvatum in the support phase | 2.4% | 6.4% | 1.6% |
Improve knee flexion in the oscillating phase | 0.8% | 1.6% | |
Facilitate knee flexion in various situations such as sitting in the wheelchair | 0.8% | ||
Reduce knee flessum | 4.0% | 0.8% | |
Facilitate shoeing | 0.8% | ||
Facilitate transfers | 0.8% | 2.4% | 2.4% |
Prevent or limit retractions | 0.8% | 1.6% | 0.8% |
Reduce spontaneous or mobilization pain | 1.6% | 0.8% | 0.8% |
Other UL | 2.4% | ||
Other LL | 3.2% | 0.8% | 5.6% |
LL | UL | ||
---|---|---|---|
General | 89.1% | 10.9% | |
Center | Center 1 Center 2 | 88.8% 90.2% | 11.2% 9.8% |
EDSS | [2; 5.5] [6; 7.5] [8; 8.5] | 100% 89.8% 44.1% | 0% 10.2% 55.9% |
Sex | M F | 88.8% 88.6% | 11.2% 11.4% |
MS phenotype | PP RR SP | 85.1% 100% 86.3% | 14.9% 0% 13.7% |
Sex | Male | Female | |||||
---|---|---|---|---|---|---|---|
Reduce a toe claw to ease gait | 12.0% | Improve stability during ground support | 9.8% | ||||
Reduce the clinging of the ground | 10.2% | Reduce the clinging of the ground | 9.0% | ||||
Improve stability during ground support | 9.3% | Reduce an equinus disturbing gait | 6.7% | ||||
Center | Center 1 | Center 2 | |||||
Improve stability during ground support | 14.8% | Improve walking perimeter | 9.1% | ||||
Reduce a toe claw to ease the gait | 11.9% | Reduce the clinging of the ground | 6.8% | ||||
Reduce the clinging of the ground | 11.5% | Improve balance | 3.8% | ||||
EDSS | [2; 5.5] | [6; 7.5] | [8; 8.5] | ||||
Reduce the clinging of the ground | 16.1% | Improve stability when ground support | 11.3% | Prevent or limit retractions | 12.5% | ||
Improve stability during ground support | 11.5% | Reduce a toe claw to ease gait | 9.3% | Other UL | 8.3% | ||
Reduce a toe claw to ease the gait | 8.6% | Reduce an equinus disturbing gait | 8.7% | Facilitate shoulder abduction | 6.3% | ||
MS Phenotype | PP | RR | SP | ||||
Reduce the clinging of the ground | 16.4% | Reduce the clinging of the ground | 16.7% | Improve stability during ground support | 11.4% | ||
Improve stability during ground support | 9.1% | Improve stability during ground support | 6.7% | Reduce a toe claw to ease the gait | 8.2% | ||
Reduce a toe claw to ease the gait | 9.1% | Improve walking perimeter | 6.7% | Reduce the clinging of the ground | 6.8% |
Goals | UL/LL | Number of Goal Selected Times | Number of Goal Achieved Times | Percentage |
---|---|---|---|---|
Improve walking perimeter | LL | 12 | 12 | 100% |
Reduce an equinus varus disturbing gait | LL | 9 | 9 | 100% |
Reduce a disturbing dystonia in hallux extension | LL | 8 | 8 | 100% |
Reduce knee flessum | LL | 6 | 6 | 100% |
Prevent or limit retractions | UL | 5 | 5 | 100% |
Prevent or limit retractions | LL | 4 | 4 | 100% |
Facilitate shoulder abduction | UL | 3 | 3 | 100% |
other | UL | 3 | 3 | 100% |
Facilitate dressing, hygiene, nursing | UL | 2 | 2 | 100% |
Reduce a hip adductum disturbing gait | LL | 2 | 2 | 100% |
Facilitate the active opening of the hand to improve prehension | UL | 1 | 1 | 100% |
Facilitate the passive opening of the hand | UL | 1 | 1 | 100% |
Reduce hand maceration | UL | 1 | 1 | 100% |
Reduce access to walking aids | LL | 1 | 1 | 100% |
Facilitate knee flexion in various situations such as sitting in the wheelchair | LL | 1 | 1 | 100% |
Facilitate shoeing | LL | 1 | 1 | 100% |
Improve stability during ground support | LL | 31 | 29 | 93.5% |
other | LL | 11 | 10 | 90.9% |
Reduce a toe claw to ease the gait | LL | 26 | 23 | 88.5% |
Facilitate transfers | LL | 7 | 6 | 85.7% |
Reduce an equinus disturbing gait | LL | 23 | 19 | 82.6% |
Reduce painful toe claw | LL | 5 | 4 | 80% |
Reduce the clinging of the ground | LL | 29 | 23 | 79.3% |
Reduce spontaneous pain or mobilization pain | UL | 4 | 3 | 75% |
Facilitate the positioning of the feet on the wheelchair pallets | LL | 4 | 3 | 75% |
Reduce a hip adductum disturbing the toilet, the dressing… | LL | 4 | 3 | 75% |
Improve walking speed | LL | 6 | 4 | 66.7% |
Facilitate the use of the hand as an auxiliary hand | UL | 3 | 2 | 66.7% |
Reduce spontaneous or mobilization pain | LL | 3 | 2 | 66.7% |
Reduce a knee recurvatum in the support phase | LL | 11 | 7 | 63.6% |
Improve balance | LL | 8 | 5 | 62.5% |
Reduce a disturbing attitude of the upper limb when walking or in other situations | UL | 2 | 1 | 50% |
Improve knee flexion in the oscillating phase | LL | 2 | 1 | 50% |
Facilitate the use of the hand in other activities (computer keyboard, tablets…) | UL | 0 | 0 | 0% |
Facilitate the wearing of a resting orthosis | UL | 0 | 0 | 0% |
Facilitate access to the perineum (probes, sexuality, toilet, hygiene…) | LL | 0 | 0 | 0% |
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Share and Cite
Baccouche, I.; Bensmail, D.; Leblong, E.; Fraudet, B.; Aymard, C.; Quintaine, V.; Pottier, S.; Lansaman, T.; Malot, C.; Gallien, P.; et al. Goal-Setting in Multiple Sclerosis-Related Spasticity Treated with Botulinum Toxin: The GASEPTOX Study. Toxins 2022, 14, 582. https://doi.org/10.3390/toxins14090582
Baccouche I, Bensmail D, Leblong E, Fraudet B, Aymard C, Quintaine V, Pottier S, Lansaman T, Malot C, Gallien P, et al. Goal-Setting in Multiple Sclerosis-Related Spasticity Treated with Botulinum Toxin: The GASEPTOX Study. Toxins. 2022; 14(9):582. https://doi.org/10.3390/toxins14090582
Chicago/Turabian StyleBaccouche, Ines, Djamel Bensmail, Emilie Leblong, Bastien Fraudet, Claire Aymard, Victorine Quintaine, Sandra Pottier, Thibaud Lansaman, Claire Malot, Philippe Gallien, and et al. 2022. "Goal-Setting in Multiple Sclerosis-Related Spasticity Treated with Botulinum Toxin: The GASEPTOX Study" Toxins 14, no. 9: 582. https://doi.org/10.3390/toxins14090582