Objective: To explore the goal attainment scale (GAS) by interviewing the three most disturbing problems and changes after Botulinum toxin A injection in cervical dystonia patients.

Background: Cervical dystonia is characterized by involuntary muscle contractions at the neck area and causes abnormal postures of the head and neck. Impact of cervical dystonia on motor and non-motor symptoms are complex and vary amongst individual patient. The most disturbing problems and the goal of treatment of cervical dystonia should be explored individually for the best management.

Method: Patients with cervical dystonia established and prioritized three personalized main problems or goals of treatment before Botulinum toxin A injection. A five-point scale ranging from -2 to +2 was used to evaluate each problem. A score of “0” referred to the achievement of the goal as expected while positive scores “+1, +2” indicated achievement more than expected, and negative scores “-1, -2” indicated achievement lower than expected. These 3 similar main problems were assessed again after 6 weeks of treatment and all scores were combined using a standard formula to derive a T-score that reflected overall achievement of treatment. The GAS T-score > 50 after botulinum toxin injection suggested that all symptoms were above patients’ expectation.

Results: 22 cervical dystonia patients (8 male, 14 female) were recruited. Total 66 personalized goals were set (3 goals per patient). 59.09% of patients reported GAS T-score > 50 after botulinum toxin injection, The mean percentage of GAS T-score changes was 41.62%. Interestingly, the three most disturbing problems were head tremor (45.45%), loss of confidence (40.90%) and neck pain (36.36%). Head tremor (90%) followed by loss of confidence (88.89%) and twisting of the neck (66.67%) were reported as the three most responsive symptoms to botulinum toxin injection.

Conclusion: Our study demonstrated that the goal of treatment of cervical dystonia should be individually explored. GAS has been shown as an applicable scale for evaluating Botulinum toxin A injection outcome in cervical dystonia patients. Head tremor was the most concerned symptoms instead of abnormal head posture and pain.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/application-of-goal-attainment-scale-as-a-patient-centered-assessment-for-cervical-dystonia/