Functional goal achievement in post-stroke spasticity patients: the BOTOX® Economic Spasticity Trial (BEST)

J Rehabil Med. 2014 Jun;46(6):504-13. doi: 10.2340/16501977-1817.


Objective: Evaluate changes in active and passive function with onabotulinumtoxinA + standard of care within goal-oriented rehabilitation programmes in adults with focal post-stroke spasticity.

Methods: Prospective, 24-week double-blind study with an open-label extension. Subjects were randomized to onabotulinumtoxinA + standard of care or placebo + standard of care, at baseline and at 12 weeks, if judged appropriate, with follow-up to 52 weeks. The primary endpoint was the number of patients achieving their principal active functional goal at 24 weeks (or 10 weeks after an optional second injection). Secondary endpoints included achievement of a different active or a passive goal at this timepoint.

Results: The intent-to-treat population comprised 273 patients. The proportion of patients achieving their principal active functional goal and secondary active functional goal with onabotulinumtoxinA + standard of care was not statistically different from placebo + standard of care. Significantly more patients achieved their secondary passive goal with onabotulinumtoxinA + standard of care (60.0%) vs. placebo + standard of care (38.6%) (odds ratio, 2.46; 95% confidence interval, 1.18-5.14) as well as higher Goal Attainment Scaling levels for upper limb and ankle flexor subgroups.

Conclusions: Addition of onabotulinumtoxinA to standard of care as part of goal-oriented rehabilitation in post-stroke spasticity patients significantly increased passive goal achievement and was associated with higher levels of active function.

Publication types

  • Clinical Trial, Phase III
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Achievement*
  • Adult
  • Aged
  • Aged, 80 and over
  • Botulinum Toxins, Type A / therapeutic use*
  • Double-Blind Method
  • Female
  • Goals*
  • Humans
  • Injections
  • Male
  • Middle Aged
  • Muscle Spasticity / drug therapy
  • Muscle Spasticity / etiology
  • Neuromuscular Agents / therapeutic use*
  • Placebos
  • Prospective Studies
  • Stroke / complications
  • Stroke Rehabilitation*
  • Young Adult


  • Neuromuscular Agents
  • Placebos
  • Botulinum Toxins, Type A