Goal Attainment and Outcome Evaluation for Upper and Lower Limb Spasticity: A Real-Life Cohort Analysis in a Community-Based Outreach Service

Botulinum toxin type A (BoNT-A) is an established treatment for spasticity. Goal Attainment Scaling (GAS), alongside standardized measures such as Arm Activity Measure (ArmA) and Leg Activity Measure (LegA), enables evaluation of patient-centered outcomes. This real-world cohort study evaluated goal attainment and standardized measure functional changes following BoNT-A for arm and/or leg spasticity, evaluated using GAS as well as passive function subscales of ArmA (ArmA-PF) and LegA (LegA-PF), and active function subscales (ArmA-AF; LegA-AF). Inclusion in the analysis was based on documented baseline and post-intervention GAS scores following BoNT-A therapy (n = 390). Across 855 treatment cycles, 1258 goals were set and categorized, of which 150 (11.9%) were related to active function and 705 (56.0%) to passive function. The mean GAS T-score improved from 36.2 to 49.4 (change 13.1, p < 0.001), with significant gains observed for both passive (change 13.7, p < 0.001) and active goals (change 12.6, p < 0.001). Passive function improved significantly on ArmA-PF (change 2.5) and LegA-PF (change 2.1), while significant changes in ArmA-AF and LegA-AF were not seen. In conclusion, goal-directed spasticity management incorporating BoNT-A resulted in improvements in goal attainment, which corresponded to a clinically meaningful change in passive function measured by ArmA-PF and LegA-PF, but not for active function. Passive function was the most common treatment priority. Findings provide real-world evidence to support community-based spasticity services and the use of structured goal setting, ArmA and LegA application, in routine practice.