Spasticity management with botulinum toxin: A comparison of UK physiotherapy and rehabilitation medicine injectors

Abstract

Background/Aims: To compare patient outcomes following botulinum toxin (BoNT) injection by either physiotherapy or rehabilitation medicine (medical) professionals over a 3-year period. Methods: A retrospective, observational cohort study was conducted in a specialised rehabilitation service providing spasticity management including BoNT injection and physical therapy (group therapy, individual therapy, self-exercise, and physical management programmes). Individualised goals were established before treatment using goal attainment scaling (GAS) by the multidisciplinary team. The Arm Activity measure (ArmA) was used to evaluate upper limb function and the Modified Ashworth Scale (MAS) used to evaluate spasticity. Findings: A total of 262 patients were injected. Mean GAS T-score after treatment for the group was 50.2 ± 6.7. GAS T-score for physiotherapy injectors (n=214 (82% of participants)) was 50.2 ± 6.4 and for rehabilitation medicine injectors (n=48 (18%)) 50.3 ± 7.9. No significant differences were identified in terms of goal achievement, upper limb passive function, or spasticity reduction between physiotherapy and rehabilitation medicine injectors. Differences were identified at both baseline (physiotherapist mean 49.7; rehabilitation medicine mean 46.6) and follow-up for active function (physiotherapist mean=49.7; rehabilitation medicine mean=47.8) (ArmA active function subscale; p=0.03). No reportable adverse effects were recorded. No difference in the complexity of injection (such as complex clinical presentation, anticoagulation, or technical difficulty) between the injector groups was identified. Conclusions: Clinical outcomes were comparable between physiotherapy and rehabilitation medicine injectors. No difference in side effect profile or complexity of injection was identified. In this cohort, injection of BoNT by a physiotherapist was as effective in terms of GAS as that undertaken by a rehabilitation medicine physician.