Preoperative disability predicts goal attainment failure after selective tibial neurotomy and rehabilitation: a 5-year follow-up study

BACKGROUND Studies assessing the effectiveness of selective tibial neurotomy (STN) assume that the procedure, combined with a rehabilitation program, reduces foot spasticity and allows the achievement of personal goals. However, few studies have reported failures in goal attainment or recurrence of spasticity, and no predictive factors have been established. OBJECTIVES To identify predictors associated with the failure to achieve personal goals after STN and rehabilitation programs. METHODS Eighty-eight adult participants with spastic foot, irrespective of the etiology, who underwent STN followed by a rehabilitation program were included. Personal goals were assessed using the Goal Attainment Scaling methodology, with T-scores calculated through a 5-year follow-up. Spasticity recurrence was defined as worsening of spasticity on the modified Ashworth scale compared with the clinical status 1 year after STN. Clinical characteristics were analyzed to identify independent predictors, which were subsequently confirmed using logistic regression. RESULTS At the 5-year follow-up, 10 participants (10/88, 11 %) had a T-score <50. Logistic regression identified the degree of preoperative disability (modified Rankin Scale ≥3, P = 0.003) as the only significant predictor of failure to achieve personal goals. Spasticity-free survival was significantly higher among participants who had achieved their goals at least as expected (P < 0.0005), suggesting a strong relationship between long-term functional gains and sustained spasticity reduction. CONCLUSION Failure to achieve personal goals after STN and a rehabilitation program is rare. However, greater preoperative disability was identified as a predictor of goal attainment failure over time.