# Longitudinal, Multi-Cycle Evaluation of Passive Function Improvement in People with Arm Spasticity Treated with Botulinum Toxin A

## TL;DR

Repeated botulinum toxin injections significantly improve passive arm function in patients with spasticity over multiple treatment cycles.

## Contribution

This study provides longitudinal evidence of cumulative improvement in passive function across multiple botulinum toxin injection cycles in real-world clinical practice.

## Key findings

- Goals for passive function were achieved in 76.2% of treatment cycles involving botulinum toxin injections.
- Significant improvements in ArmA-PF scores were observed for at least six consecutive treatment cycles (p < 0.001).
- Cumulative benefits were sustained regardless of most patient-related baseline characteristics.

## Abstract

Improvement in passive function (i.e., ease of caring for a limb) is a common goal for treatment of spasticity in the arm with botulinum toxin. A large international, observational, 2-year longitudinal study (ULIS-III, N = 953) was conducted in real-life practice. This original secondary analysis examines whether improvement in passive function goals were met over repeated injection cycles. We report changes by cycle measured by the Passive Function sub-scale of the Arm Activity measure (ArmA-PF) and examine predictors of improvement and injection occurrence. Inclusion in this analysis was based on passive function being selected as a primary or secondary goal for one or more cycle of treatment (n = 542/953). Goals were assessed at the start and end of each cycle using the Goal Attainment Test score and the ArmA-PF. Over all cycles of treatment, goals were set for 1641/2187 injections (75.0%) and achieved in 1250 (76.2%). Significant improvements in ArmA-PF score were identified for at least six cycles (p < 0.001) with evidence of cumulative benefit over successive cycles. This occurred regardless of patient-related baseline characteristics, with the possible exception of some relationship with injection localization techniques. In conclusion, repeated botulinum toxin injections provide significant improvement in passive function, which was sustained over repeated cycles of treatment.