Improving detection of candidates for botulinum toxin therapy in spasticity: an interprofessional screening approach

Spastic movement disorders (SMD) are commonly treated with botulinum toxin, however, many patients who may benefit from treatment remain unrecognized in routine clinical practice. Early identification is particularly challenging in non-specialized settings. This study evaluated the diagnostic performance of interprofessional screening tools for identifying patients with clinically relevant SMD requiring referral for specialist assessment.

In this prospective, two-phase, single-center study, 124 patients who received care by departments of neurology and geriatrics were included. In phase 1, the Spastic Movement Disorder decision tree (SMD-DT) was applied independently by nurses, physiotherapists, and occupational therapists and compared with the clinical assessment of an experienced neurologist as the reference standard. Based on the findings, a simplified nursing screening tool, the Salzburg Nursing Questionnaire (SNQ), was developed and subsequently evaluated in independent cohorts in phase 2 of the study.

The SMD-DT demonstrated high agreement with the reference standard in neurological rehabilitation settings, with a high degree of consistency across all professional groups compared with the expert, but showed substantially lower performance among nurses in non-specialized geriatric settings. In contrast, the SNQ consistently achieved high diagnostic accuracy in these settings (sensitivity of 1.00 and specificity of 0.96) considering treatment recommendation.

The diagnostic performance of screening instruments for SMD depends strongly on both clinical context and professional background. These findings support the implementation of profession-specific screening strategies to improve early recognition of clinically relevant SMD, facilitating timely referral for specialist evaluation, and optimize access to botulinum toxin therapy in routine clinical practice.