Ashford, Stephen ABuchwald, KhanFheodoroff, KlemensJacinto, JorgeNarayanan, AjitSiegert, Richard JHannes, ChristianTurner-Stokes, Lynne2026-01-262026-01-262026-01-19Toxins, ISSN: 2072-6651 (Print); 2072-6651 (Online), MDPI AG, 18(1), 51-51. doi: 10.3390/toxins180100512072-66512072-6651http://hdl.handle.net/10292/20543Improvement in passive function (i.e., ease of caring for a limb) is a common goal for treatment of spasticity in the arm with botulinum toxin. A large international, observational, 2-year longitudinal study (ULIS-III, N = 953) was conducted in real-life practice. This original secondary analysis examines whether improvement in passive function goals were met over repeated injection cycles. We report changes by cycle measured by the Passive Function sub-scale of the Arm Activity measure (ArmA-PF) and examine predictors of improvement and injection occurrence. Inclusion in this analysis was based on passive function being selected as a primary or secondary goal for one or more cycle of treatment (n = 542/953). Goals were assessed at the start and end of each cycle using the Goal Attainment Test score and the ArmA-PF. Over all cycles of treatment, goals were set for 1641/2187 injections (75.0%) and achieved in 1250 (76.2%). Significant improvements in ArmA-PF score were identified for at least six cycles (p < 0.001) with evidence of cumulative benefit over successive cycles. This occurred regardless of patient-related baseline characteristics, with the possible exception of some relationship with injection localization techniques. In conclusion, repeated botulinum toxin injections provide significant improvement in passive function, which was sustained over repeated cycles of treatment.© 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.3214 Pharmacology and Pharmaceutical Sciences32 Biomedical and Clinical SciencesClinical Research6.1 Pharmaceuticals0601 Biochemistry and Cell Biology1115 Pharmacology and Pharmaceutical Sciences3214 Pharmacology and pharmaceutical sciencespassive functionbotulinum toxinarm spasticitygoal attainment scalingrehabilitationupper limb spasticityreal-world evidenceJournal ArticleOpenAccess10.3390/toxins18010051