Abstract
BackgroundBotulinum toxin (BT) injection is a new treatment for spasticity with hemiplegia after stroke. How a patient decides to receive BT injections after becoming aware of the treatment remains unclear. In this exploratory qualitative study, we aimed to investigate patients’ decision-making about treatment strategies in collaboration with family and health professionals and to identify conflicts in patients’ feelings about BT treatment.MethodsThe study included six patients with stroke sequelae. Data were collected using comprehensive interviews and were analyzed using the grounded theory approach and trajectory equifinality modeling.ResultsAfter patients learned about BT treatment, they clearly exhibited the following two concurrent perceptions: “the restriction of one’s life due to disabilities” and “the ability to do certain things despite one’s disabilities.” Some patients reported a “fear of not being able to maintain the status quo owing to the side effects of BT.” To alleviate this fear, timely support from family members was offered, and patients overcame anxiety through creative thinking. However, there were also expressions that revealed patients’ difficulties dealing with negative events. These factors influenced the patients’ development of “expectations of BT” or “hesitations about BT.”ConclusionsTo establish treatment strategies in collaboration with patients, healthcare professionals should show supportive attitudes and have discussions with patients and their family members to help patients resolve their conflicts and should establish treatment strategies that maintain the positive aspects of patients’ lives.
Highlights
Botulinum toxin (BT) injection is a new treatment for spasticity with hemiplegia after stroke
Some studies have reported that no increase in activity or improvement in quality of life (QOL) was observed after BT injections, even though spasticity decreased [9]
By understanding BT, the patients began to shift from a focus on “the restriction of one’s life due to disabilities” to a focus on the “BT effects that correspond to the restriction of one’s life and the emergence of an image of desired treatment,” e.g., “If I receive this injection, I believe that my legs will turn a little toward the outside.”
Summary
Botulinum toxin (BT) injection is a new treatment for spasticity with hemiplegia after stroke. Spasticity as a sequela of stroke Spasticity is a positive symptom of upper motor neuron disorders and is commonly associated with hemiplegia after stroke [1] It leads to various problems in a patient’s life, including difficulties with dressing, locomotion, hygiene maintenance and pain, as well as the deterioration of nutritional status [1]. These problems further aggravate spasticity, leading to a vicious cycle involving spasticity and its associated problems, such as a distorted self-image, impacts on the fulfillment of parent or partner life roles, and social isolation [1].
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