PND37 - Resource Use Related to Pediatric Lower Limb Spasticity in Canada: Physician Questionnaire

Abstract

Lower limb spasticity is a disabling feature common among children with cerebral palsy. Treatment goals are functional and patient-specific. The aim is often to improve mobility and reduce pain and discomfort. In Canada, health resource use (RU) among this patient population is largely unknown. The objective of this study was to characterize RU associated with management of pediatric lower limb spasticity. A RU questionnaire was developed and administered to a sample of Canadian physicians who regularly treat children with lower limb spasticity. A clinical expert provided guidance during questionnaire design. Physicians were contacted via email with requests to collaborate, and the 30-minute phone questionnaire was administered by a trained researcher. Questionnaire results were synthesized and ranges of numerical responses reported. Six physicians from across Canada completed the questionnaire. Medical specialties included pediatrics, orthopedics, and neurosurgery. Among pediatric spasticity patients, RU was reported by physicians to differ for unilateral compared to bilateral spasticity, and by baseline gross motor function. Individuals are primarily managed in the outpatient setting. Annual outpatient visits include specialist office (2-3 per year), physiotherapy (6-20 per year), and botulinum toxin A injections (2-4 per year). Hospitalizations for spasticity management are rare. Radiology visits may include annual hip surveillance X-rays. Current pharmacotherapies for lower limb spasticity include oral baclofen and botulinum toxin A, including off-label use, as it has historically only been indicated in specific subtypes of lower limb spasticity. Lower limb orthopedic surgeries are relatively common in this population; neurosurgeries occur less frequently and among severe cases only. Children with lower limb spasticity in Canada have high rates of outpatient RU. Botulinum toxin A is a common treatment for pediatric limb spasticity in Canada, despite being used off-label for this indication. An observational study is warranted to further validate RU in this patient population.