{
  "abstract": "Improvement in active function (making it easier to use the limb) is a common goal following treatment of upper limb spasticity with botulinum toxin (BoNT-A). ULIS-III was a large international, observational, longitudinal study (N = 953) conducted in the context of usual clinical practice over two years. In this secondary post hoc analysis, we examine whether goals for improvement in active function were met over repeated injection cycles. Patients were selected if improved active function (AF) was a primary/secondary goal for at least one cycle of treatment (n = 286/953). They were assessed at the start and end of each cycle using the Goal Attainment T-score alongside the Arm Activity measure (ArmA). Serial changes and predictors of improvement were explored. Across eight cycles, there were 1167 injections for active function, 875/1998 (44%) AF goals were set and 493 (57%) of those goals were achieved. Patients continued to show significant improvement in AF (p < 0.001) for each injection at least up to three cycles, which is likely to be clinically significant, especially in patients with milder spasticity who were naïve to BoNT-A. No statistically significant predictors were confirmed on mixed effects modeling. Conclusions: Repeated BoNT-A continued to produce significant improvement in active function for at least three cycles, regardless of patient- or treatment-related factors in this cohort, but type II errors due to small numbers cannot be excluded.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London SE5 9PJ, UK.",
    "Regional Hyper-Acute Rehabilitation Unit, Northwick Park Hospital, London North West University Hospitals, London HA1 3UJ, UK.",
    "Faculty of Medicine, University of Otago, Dunedin 9016, New Zealand.",
    "Neurorehabilitation, Gailtal-Klinik, 9620 Hermagor, Austria.",
    "Centro de Medicina de Reabilitaçãode Alcoitão, Serviço de Reabilitação de Adultos 3, 2649-506 Estoril, Portugal.",
    "Department of Psychology and Neuroscience, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland 0627, New Zealand.",
    "Ipsen, Einsteinstraße 174, 81677 Munich, Germany."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Stephen A Ashford",
      "orcid": "0000-0001-5541-7063"
    },
    {
      "affs": [
        2
      ],
      "name": "Mark Weatherall",
      "orcid": "0000-0002-0051-9107"
    },
    {
      "affs": [
        3
      ],
      "name": "Klemens Fheodoroff",
      "orcid": "0000-0002-6508-5055"
    },
    {
      "affs": [
        4
      ],
      "name": "Jorge Jacinto",
      "orcid": "0000-0002-3428-2312"
    },
    {
      "affs": [
        5
      ],
      "name": "Richard J Siegert"
    },
    {
      "affs": [
        6
      ],
      "name": "Christian Hannes"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Lynne Turner-Stokes",
      "orcid": "0000-0002-3302-9462"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/cx7y0cm0hdmf6.bib",
  "cited_by": 0,
  "doi": "10.3390/toxins18100429",
  "fulltext_url": "https://europepmc.org/articles/PMC13709561",
  "id": "cx7y0cm0hdmf6",
  "issns": [
    "2072-6651"
  ],
  "landing_url": "https://europepmc.org/article/MED/42931520",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2728|Botulinum Toxin and Related Neurological Disorders"
    ]
  ],
  "openalex": "W7216296295",
  "pdf_url": "https://europepmc.org/articles/PMC13709561?pdf=render",
  "pmcid": "PMC13709561",
  "pmid": "42931520",
  "published": "2026-10-02",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/cx7y0cm0hdmf6.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:22:01Z",
      "native_id": "MED:42931520",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42931520"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2728|Botulinum Toxin and Related Neurological Disorders",
      "subfield": "neurology"
    }
  ],
  "title": "Active Function Improvement with Repeated Injections of Botulinum Toxin A in Upper Limb Spasticity: A Longitudinal Analysis from the ULIS-III Study.",
  "title_text": "Active Function Improvement with Repeated Injections of Botulinum Toxin A in Upper Limb Spasticity: A Longitudinal Analysis from the ULIS-III Study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:22:01Z",
  "url": "https://research.draconitic.com/paper/cx7y0cm0hdmf6",
  "venue": "Toxins",
  "versions": []
}