Abstract
Ultrasound (US)-guided botulinum neurotoxin (BoNT) injections are becoming a mainstay in the treatment of muscle spasticity in upper motor neuron syndromes. As a result, there has been a commensurate increase in US-guided BoNT injection for spasticity training courses. However, many of these courses do not emphasize the importance of ergonomics. This paper aims to highlight the importance of ultrasound ergonomics and presents ergonomic recommendations to optimize US-guided BoNT injection techniques in spasticity management. Expert consensus opinion of 11 physicians (4 different continents; representing 8 countries, with an average of 12.6 years of practice using US guidance for BoNT chemodenervation (range 3 to 22 years)). A search using PubMed, College of Physicians and Surgeons of British Columbia database, EMbase was conducted and found no publications relating the importance of ergonomics in US-guided chemodenervation. Therefore, recommendations and consensus discussions were generated from the distribution of a 20-question survey to a panel of 11 ultrasound experts. All 11 surveyed physicians considered ergonomics to be important in reducing physician injury. There was complete agreement that physician positioning was important; 91% agreement that patient positioning was important; and 82% that ultrasound machine positioning was important. Factors that did not reach our 80% threshold for consensus were further discussed. Four categories were identified as being important when implementing ultrasound ergonomics for BoNT chemodenervation for spasticity; workstation, physician, patient and visual ergonomics. Optimizing ergonomics is paramount when performing US-guided BoNT chemodenervation for spasticity management. This includes proper preparation of the workspace and allowing for sufficient pre-injection time to optimally position both the patient and the physician. Lack of awareness of ergonomics for US-guided BoNT chemodenervation for spasticity may lead to suboptimal patient outcomes, increase work-related injuries, and patient discomfort. We propose key elements for optimal positioning of physicians and patients, as well as the optimal setup of the workspace and provide clinical pearls in visual identification of spastic muscles for chemodenervation.
Highlights
Ergonomics is defined as the study of human factors affecting the worker [physician], with a focus on observing how people interact with their work environment and adapting the workplace to the worker, their abilities and limitations [1]
The average years of experience regarding using ultrasound guidance for botulinum neurotoxin (BoNT) chemodenervation among the injectors was 12.6 years and the average years of experience with teaching medical students, post-graduate training physicians and junior physician staff relating to US-guided BoNT chemodenervation was 10.5 years
There was 100% agreement that ergonomics in US-guided BoNT chemodenervation is important in reducing physician injury and 81% agreement that ergonomics is important for clinics to run efficiently
Summary
Ergonomics is defined as the study of human factors affecting the worker [physician], with a focus on observing how people interact with their work environment and adapting the workplace to the worker, their abilities and limitations [1]. When applied to physicians using ultrasound (US) guidance for botulinum neurotoxin (BoNT) injections for spasticity, this consists of analyzing the physical relationships between the physicians, their patients, and their work environment to optimize comfort and treatment outcomes. The targeting of muscles for chemodenervation using BoNT was guided by a combination of anatomical landmarking, direct muscle stimulation with electrical stimulation, and electromyography. US guidance is becoming an increasingly utilized guidance method for chemodenervation in patients with spasticity and may provide greater anatomic accuracy when compared to traditional methods [2,3,4]. US is a reproducible method for assessing muscle structural architecture which may help guide spasticity treatment in the future [5,6]
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