Papers by Stephen Ashford
The Upper Limb International Spasticity (ULIS-II) Study: UK versus global results
Evaluation of internal consistency and reliability of the arm activity measure (ArmA).: 5th World Congress for NeuroRehabilitation, Brazilia, Brazil
The Royal College of Physicians The Royal College of Physicians (RCP) plays a leading role in the... more The Royal College of Physicians The Royal College of Physicians (RCP) plays a leading role in the delivery of high-quality patient care by setting standards of medical practice and promoting clinical excellence. The RCP provides physicians in over 30 medical specialties with education, training and support throughout their careers. As an independent charity representing over 34,000 fellows and members worldwide, the RCP advises and works with government, patients, allied healthcare professionals and the public to improve health and healthcare.
Goal attainment scaling to detect functional gains from botulinim toxin injection for management of the spastic upper limb. Poster Presentation
Evaluation of internal consistency and reliability of the arm activity measure (ArmA)
A comprehensive person-centered approach to adult spastic paresis: a consensus-based framework
European Journal of Physical and Rehabilitation Medicine, Jun 1, 2018
Spastic paresis is a common feature of an upper motor neuron impairment caused by stroke, brain i... more Spastic paresis is a common feature of an upper motor neuron impairment caused by stroke, brain injury, multiple sclerosis and other CNS disorders. Existing national and international guidelines for the treatment of adult spastic paresis tend to focus on the treatment of muscle overactivity rather than the comprehensive approach to care, which may require life-long management. Person-Centred Care is increasingly adopted by healthcare systems in a shift of focus from 'disease-oriented' towards 'person-centred' medicine. The challenge is to apply this principle to the complex management of spastic paresis and to include an educative process that engages care providers and patients and encourages them to participate actively in the long-term management of their own disease. To address this issue, a group of 13 international clinicians and researchers used a pragmatic top-down methodology to evaluate the evidence and to formulate and grade the strength of recommendations for applying the principles of person-centred care to the management of spastic paresis. There is a distinct lack of clinical trial evidence regarding the application of person-centred medicine to the rehabilitation setting. However, the current evidence base supports the need to ensure that treatment interventions for spastic paresis should be centred on as far as reasonable on the patient's own priorities for treatment. Goal setting, negotiation and formal recording of agreed SMART goals should be an integral part of all spasticity management programmes, and goal attainment scaling should be recorded alongside other standardised measures in the evaluation of outcome. When planning interventions for spastic paresis, the team should consider the patient and their family's capacity for self-rehabilitation, as well as ways to enhance this approach. Finally, the proposed intervention and treatment goals should consider the impact of any neuropsychological, cognitive and behavioural deficits on rehabilitation. These recommendations support a person-centric focus in the management of spastic paresis.
Integrated Upper Limb Spasticity Management Including Botulinum Toxin A on Patient-centred Goal Attainment: The ULIS-III Study (1181)
Neurology, Apr 14, 2020
Assessing the Effectiveness of AbobotulinumtoxinA Injections for Adult Lower Limb Spasticity in Routine Clinical Practice: Methodology and Baseline Data for the AboLiSh Study
Toxicon, Jul 1, 2022
Factors Associated With Favorable Response in Real-World Use of Botulinum Toxin Type A Products for Adult Patients With Upper Limb Spasticity
Toxicon
Spasticity in adults: management using botulinum toxin. National guidelines. Second Edition
Royal College of Physicians, Mar 20, 2018
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
Journal of Rehabilitation Medicine, 2021
Objective To describe the utility of a structured approach to assessing effectiveness following i... more 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 clinicaltrials.gov 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. LAY ABSTRACT This paper presents the first results from the ULIS-III study, a large international study which explores real life clinical practice in the integrated management of upperlimb spasticity, using Botulinum Toxin-A (BoNT-A) in conjunction with physical therapies. ULIS-III is the first study to use the Upper Limb Spasticity Index (ULS Index), a system for assessing the benefits of treatment that combines recording how well the intended goals for treatment were achieved, alongside standardized measures to improve the comparability of outcomes. The data confirm good overall response rates. Importantly, when standardized measures are appropriately targeted on the individual’s priority treatment goals, they demonstrate clear measurable improvements in daily function. It is also the first study to use the Upper Limb Spasticity Therapy Recording Schedule (ULSTR) to systematically record and describe the physical therapies provided. It shows how this information helped us to explore differences between BoNT-A products in the time that each injection lasts before the next one is needed.
Clinical Trial Adherence to Focal Muscle Spasticity Guidelines: A Systematic Review
Archives of Physical Medicine and Rehabilitation, 2021
Impact of patient input on the study execution of an observational study assessing the effectiveness of abobotulinumtoxinA treatment in leg spasticity management in adults
Toxicon, 2021
Botulinum toxin a in upper limb spasticity management: Baseline data from the upper limb international spasticity (ULIS)–III study
Annals of Physical and Rehabilitation Medicine, 2018
Introduction/Background ULIS-III describes real-life clinical practice in upper limb spasticity (... more Introduction/Background ULIS-III describes real-life clinical practice in upper limb spasticity (ULS) management using licensed botulinum toxin A (BoNT-A) products and concomitant therapies. ULIS-III assesses long-term impact on patient-centred outcomes and identifies best practice strategies according to patient needs. Baseline data are presented for patients enrolled by June 2017. Material and method This longitudinal, prospective, observational, cohort study of integrated ULS management in adults ( NCT02454803 ) examines impact of repeated BoNT-A injections over 2 years. Person-centred outcomes are assessed using the Upper Limb Spasticity Index, combining individual goal setting with targeted standardised measures, using patient-selected goal areas. Injection practices and physical treatments are recorded, alongside economic and quality-of-life data. Results Baseline data were analysed for 975 patients across 57 sites (14 countries; 5 continents). Table 1 presents baseline characteristics; 82% of patients had spasticity post-stroke; two-thirds had received previous BoNT-A for ULS ( 10 injections, 28%). Median time from diagnosis to first injection and enrolment was 1.0 and 3.4 years, respectively. Baseline muscle tone and disability measures are shown in Table 1 . Upper arm and forearm muscles were most commonly injected; 34% received concomitant BoNT-A for lower limb spasticity ( Table 2 ). Shoulder injection frequency increased since ULIS-II (e.g. pectoralis major: 34 vs. 19%). Instrumental injection guidance techniques were used in 73% of patients. Most common primary goal areas were passive function (31%) and pain (25%), showing notable changes in goal selection since ULIS-II ( Fig. 1 ). Conclusion ULIS-III contributes to greater understanding of achievable treatment goals and developing practice with improved clinical reasoning, as reflected in ULIS-III baseline data. ULIS-III will improve understanding of treatment and outcomes for long-term ULS management. Final data are expected in 2019.
Poster 55: Relief of Spasticity-Related Pain with Botulinum Neurotoxin-A (BoNT-A) in Real Life Practice. Post-Hoc Analysis from a Large International Cohort Series
PM&R, 2018
Poster 52: Botulinum Toxin A in Upper Limb Spasticity Management: Baseline Data from the Upper Limb International Spasticity (ULIS)-III Study
PM&R, 2018
worst pain, respectively. Between-group differences were significant in actual and least pain (P ... more worst pain, respectively. Between-group differences were significant in actual and least pain (P < .05). Significant treatment effect in favor of ITB was observed in EQ-5D utility score: mean change was 0.09 (0.26) for ITB compared to 0.01 (0.16) for CMM (P < .05). EQ-5D health status score increased by 9.68 (20.42) for ITB versus 4.40 (21.75) for CMM (P >.05). In total 17 (68%) ITB implanted patients reported at least one treatment-related adverse event versus 7 (20%) CMM patients. No patient discontinued ITB therapy due to a treatment-related adverse event. Conclusions: The study demonstrated superiority of ITB therapy versus conventional oral medication in decreasing muscle hypertonia in post-stroke patients with spasticity. This is associated with improvements in pain and quality of life in ITB patients. Level of Evidence: Level I
Poster 373-C Integrated Upper Limb Spasticity Management Including Botulinum Toxin A (BoNT-A) on Patient-Centered Goal Attainment: Methodology for ULIS-III and Initial Goal-Setting Data
PM & R : the journal of injury, function, and rehabilitation, 2016
Disclosures: Lynne Turner-Stokes: no disclosure on file Objective: To describe the methodology fo... more Disclosures: Lynne Turner-Stokes: no disclosure on file Objective: To describe the methodology for the Upper Limb International Spasticity study (ULIS) III, and describe an initial evaluation of goal-setting. Design: Non-interventional 2-year longitudinal cohort study. Setting: International, multicenter. Participants: Patients with upper limb spasticity (ULS) receiving botulinum toxin A (BoNT-A). Interventions: Repeated botulinum toxin A injections as part of integrated upper limb spasticity management in real-life clinical practice. Main Outcome Measures: ULS Index and Goal Attainment Scaling— Evaluation of Outcome for ULS (GAS eous) tool will be utilized to evaluate functional changes following BoNT A treatments. GAS eous provides a structured framework for application alongside standardized outcome measures in a clinical setting. Economic, quality of life data, and concomitant therapy use will also be recorded. Results: Recruitment began in January 2015; by 01 November 2015, initial goal-settingdata hadbeen collected for 242patients across 29 sites in 8 countries. Centers were awarded a rating based on the quality of goal statements set. Overall, 20/28 centers achieved the highest rating (A++) (one site was not accessible). One primary goal and 1 secondary goals were set for eachpatient. 236patientshad setprimarygoals anda total of 201 secondary goals were also set; 88 patients had only the primary goal set, 95 patients had set two goals (oneofwhichwasa primary goal) and 53 patients had set three goals (one of which was the primary goal). The commonest primary goal areas identified were passive function (40 patients) and active function (25 patients) followed by pain and range of movements/prevention of contractures (17 patients each). Conclusions: ULIS-III will implement novel approaches for evaluating patient centered goal attainment and a structured and consistent method of recording data. High-quality goal-setting was demonstrated in the majority of centers. Study results will be reported in peerreviewed journals and at international meetings. Level of Evidence: Level II
Relationship between abobotulinumtoxina injections into shoulder muscles and patient-centered primary goal selection and achievement: Subanalyses from the upper limb international spasticity (ULIS)-II study
Toxicon, 2016
Integrated upper limb spasticity management including botulinum toxin A (BoNT-A) on patient-centred goal attainment: Methodology for ULIS-III and initial goal-setting data
Toxicon, 2016
Poster 57: Time to Retreatment with Botulinum Toxin A in Upper Limb Spasticity Management: Initial Data from the Upper Limb International Spasticity (ULIS)‐III Study
PM&R, 2017
were fall resulting in landing with head on the ground (4; two got tackled by another player, one... more were fall resulting in landing with head on the ground (4; two got tackled by another player, one somersaulted for goal-celebration and one collided with another player), heading the ball (2) and direct head collision with another player (1). Thoracic SCI occurred due to fall on upper back while stretching to intercept ball and SCI symptoms only arose after 20 minutes of continuous play after the impact. Lumbar SCI was due to fall on lower back after colliding with another player. The player who performed goal-celebration somersault died instantaneously. 8/9 sustained acute SCIs during game time, whereas one had chronic cervical SCI due to repeated heading of the ball. 7/8 acute cases got SCI symptoms immediately after the impact. Less than a quarter of players could have continued playing soccer after recovering from SCI. More details, including management and outcomes of the SCIs suffered by most soccer players could not be studied due to unavailability of related records. Conclusions: Soccer players sustain SCI very rarely during a game or training session. However, SCI has potential to cause career-ending and catastrophic tragedy. Further studies need to be done for detailed understanding on prevention, patterns, management and outcomes of SCI in soccer players. Level of Evidence: Level IV
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Papers by Stephen Ashford