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Practice Patterns of Physicians Using Adjunct Therapies with Botulinum Toxin Injection for Spasticity: A Canadian
Alvin H Ip1, Chetan P Phadke2,3, Chris Boulias2,4
1Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Summary
Canadian physicians commonly use adjunct therapies with botulinum toxin (BoNT) injections for spasticity. Barriers like cost and time limit the use of evidence-supported therapies, necessitating research into more accessible options.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Physical Therapy
Background:
- Adjunct therapies are non-pharmacological treatments used alongside botulinum toxin (BoNT) injections to enhance spasticity management.
- While recommended for comprehensive care, the specific adjunct therapies utilized in clinical practice remain unclear.
Purpose of the Study:
- To investigate physician practices and perceptions regarding the use of adjunct therapies following BoNT injections for limb spasticity.
Main Methods:
- A national cross-sectional survey was conducted among 48 Canadian physicians administering BoNT for limb spasticity.
- A 22-item questionnaire assessed the types of adjunct therapies used and physician opinions on barriers and patient preferences.
Main Results:
- Home exercise programs and splinting are frequently prescribed, though physicians perceive patient reluctance.
- Electrical stimulation (ES) and transcutaneous electrical nerve stimulation (TENS) are used less frequently, with financial and evidence-based barriers cited.
- Academic physicians were more likely to use ES and TENS compared to non-academic counterparts.
Conclusions:
- Canadian physicians widely incorporate adjunct therapies with BoNT for spasticity.
- Financial and time constraints, along with patient preferences, hinder the adoption of evidence-based adjunct therapies.
- Future research should prioritize adjunct therapies that address these implementation barriers.
