Goal analysis in patients with limb spasticity treated with incobotulinumtoxinA in the TOWER study.

[PURPOSE] To map spasticity-related goals using the International Classification of Functioning, Disability and Health (ICF) linking rules, and review goal syntax to direct future goal setting.

[MATERIALS AND METHODS] 1633 treatment goals, set during the TOWER study, were linked to the ICF framework and EQ-5D domains. Goals were mapped independently by two investigators with expertise in ICF linking rules.

[RESULTS] In total, 1630 (99.8%) goals could be mapped to the ICF (inter-rater agreement on the main ICF category 96.1%). Most goals (80.2%) were mapped to a single ICF category and were related to activities/participation (54.9%). 170 (10.4%) goals were related to general tasks and activities, such as positioning, stretching, and strengthening. In total, 1072 goals (65.6%) mapped to the EQ-5D domains (inter-rater agreement 90.8%). Analysis of the goal syntax highlighted the need to include a verb in patient-centered goals to direct active behavior.

[CONCLUSIONS] The ICF offers a broad framework for setting patient-centered, easily understandable goals for patients with spasticity, including goals related to (guided) self-management activities. This analysis sheds new light on patient needs and could direct future goal-driven botulinum toxin spasticity treatment focused on enabling patients to better manage activity limitations imposed by their body function impairments. NCT01603459 registered with ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT01603459).Implications for RehabilitationThe ICF offers a broad framework for setting patient-centered, easily understandable goals for patients with spasticity.ICF domains that include general tasks and demands can be used to establish goals relating to (guided) self-management of spasticity.An ICF-based goal-setting framework may increase the comparability of clinical data across studies.