The effect of botulinum toxin type A treatment of the lower extremity on the level of functional abilities in children with cerebral palsy: evaluation with goal attainment scaling

Abstract

Objective: To measure the effect of botulinum toxin type A (BTX-A) treatment in children with cerebral palsy with regard to individual goals concerning functional abilities, using goal attainment scaling.

Design: A single-blind randomized multiple baseline/treatment phase design across subjects.

Setting: The paediatric department of a rehabilitation centre.

Subjects: Eleven children with cerebral palsy participated.

Intervention: BTX-A treatment of the lower extremity.

Main measures: A six-point goal attainment scaling of three individual treatment goals at the level of functional abilities. Standardized video-tapes of each goal were recorded weekly for a period of 14 weeks. Rating on the predetermined goal attainment scaling was blinded.

Results: Nine of the 11 subjects showed significant improvement in 18 out of 33 goals. Seven subjects showed clinically relevant improvement (at least 2 points on the goal attainment scaling) in 11 goals. Testing the difference between all medians of baseline measurements (after correction for improvement during baseline) and the medians of the treatment phase measurements for all goal attainment scaling scores (n < 33) resulted in significant improvement (p < 0.001). Tested at subject level (medians of the three goal attainment scaling scores per assessment, n < 11), a significant improvement was also found (p < 0.005). The change in goal attainment scaling score was related to the moment of treatment with BTX-A.

Conclusion: Clinically relevant improvement in individual rehabilitation goals at ability level, achieved with the treatment of BTX-A in children with cerebral palsy, were demonstrated using the goal attainment scaling method.