Assessing the effectiveness of upper-limb spasticity management using a structured approach to goal-setting and outcome measurement: First cycle results from the ulis-III study

Lynne Turner-Stokes, Jorge Jacinto, Klemens Fheodoroff, Allison Brashear, Pascal Maisonobe, Andreas Lysandropoulos, Stephen Ashford, Ian Baguley, Arun Aggarwal, John Olver, John Estell, Steven Faux, Edwin Luk, Katya Kotschet, Andrew Hughes, Rachael Nunan, Bernhard Haslinger, Petra Baum, Cornelia Mobius, Urban FietzekIp Chi Wang, Tae Mo Chung, Régina Helena Chueire, Carla Heloisa Cabral Moro, Alexis Schnitzler, Claire Delleci, Anne Laure Ferrapie, Marie Eve Isner-Horobeti, Dominic Perennou, Ching Man Leung, Michela Cosma, Carlo Caltagirone, Manuela Diverio, Paolo Girlanda, Giancarlo Ianeri, Marzia Millevolte, Franco Molteni, Jorge Hernandez Franco, Juan Francisco Gomez Hernandez, Sandra Quinones Aguilar, Laura Patricia de la Lanza Andrade, Raymond Rosales, Jeanne Flordelis, Dariusz Koziorowski, Anna Potulska, Monika Rudzinska, Eduarda Afonso, Ana Rolo Duarte, Svetlana Khatkova, Alexey Korenko, Dina Khasanova, Dmitry Okhabov, Elena Arefyeva, Denis Karpov, Andrey Korolev, Yi Chung Lee, Sen Wei Tsai, Jessica Tate, Thomas L. Davis, Cynthia Marciniak, Atul Patel

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: To describe the utility of a structured approach to assessing effectiveness following injection with botulinum toxin-A alongside physical therapies, within the first cycle of the Upper Limb International Spasticity-III (ULIS-III) study. Methods: ULIS-III (registered at as NCT02454803) is a large international, observational, longitudinal study of adults treated for upper-limb spasticity. It introduces novel methods for the structured evaluation of person-centred goal attainment alongside targeted standardized outcome measures: the Upper limb Spasticity Index, and the Upper Limb Spasticity Therapy Recording Schedule. Results: A total of 953/1,004 enrolled patients (95%) completed cycle 1. Mean overall goal attainment scaling (GAS) T scores were 49.8 (95% confidence interval 49.2-50.3; 67.1% of patients met their primary goal, with highest achievement rates for goals related to involuntary movement, (75.6%) and range of movement (74.4%). Standardized measures of spasticity, pain, involuntary movements, active and passive function, all improved significantly over the treatment cycle. Overall, 59.7% of patients saw a therapist following botulinum toxin-A injection. Interventions varied, as expected, with the set treatment goals. After controlling for concomitant therapies using the upper limb spasticity therapy recording schedule, significant differences in injection intervals (p< 0.001) were seen between the commercially-available botulinum toxin-A agents. Conclusion: The results of this study confirm the utility of the Upper Limb Spasticity Index and Upper Limb Spasticity Therapy Recording Schedule as a structured approach to capturing goal-setting, therapy inputs and outcomes assessment.

Original languageEnglish (US)
Article numberjrm00133
JournalJournal of Rehabilitation Medicine
Issue number1
StatePublished - Jan 2021
Externally publishedYes


  • Botulinum toxin-A
  • Goal attainment scaling
  • Physical therapy
  • Post-stroke spasticity
  • Stroke rehabilitation

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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