TY - JOUR
T1 - Ultrasound image guided injection of botulinum toxin for the management of spasticity
T2 - A Delphi study to develop recommendations for a scope of practice, competency, and governance framework
AU - Ashford, Stephen A.
AU - Morris, Gary
AU - Smith, Michael J.
N1 - Funding Information:
The authors would particularly like to thank participants in the Delphi consultation process for freely giving up their time and sharing their expertise. Special thanks therefore go to: Ganesh Bavikatte, Paul Winston, Sergio Lerma, Cameron Lindsay, Klemens Fheodoroff, Lynsay Duke, Rachel Farrell, Gerry Christofi, Felicia Wong, Katrina Buchanan, Alison Barclay, Peter Moore, Dave Purdy, Karl Jackson, and Claire Haddock. Disclosures: Stephen Ashford has an interest in outcomes development, evaluation and psychometrics. He has published on the use of Goal Attainment Scaling in this context, as well as standardized measures, such as the Arm and Leg Activity measures. These tools are freely available, and he has no personal financial interest in these measures. He has received honoraria from Ipsen, Allergan (Abbvie), Merz, Danone and research grants from Ipsen, NIHR, Dunhill, London North West Health and ACPIN. Mike Smith receives (paid to his employing institution) consultancy pay from Exo.inc. Gary Morris has nothing to disclose. Ethical approval was granted by the School of Healthcare Sciences, Research Governance and Ethics committee, Cardiff University (reference: REC793). Invitations were disseminated with written information about the study and participants were given the opportunity to ask questions. Consent to participate was assumed from participants’ response to the invitation and subsequent completion of the Delphi survey.
Publisher Copyright:
© 2023 The Authors
PY - 2023/12/1
Y1 - 2023/12/1
N2 - Objective: To establish a scope of practice, competency (through education) and governance framework for ultrasound image guided injection of botulinum toxin in the management of spasticity Design: Delphi study Setting: International, web-based survey Participants: A purposively selected multidisciplinary (physicians, physiotherapists, occupational therapists) panel of experts (n=15) in the use of ultrasound image guided injection of botulinum toxin for management of spasticity. Panel members were predominantly based in the UK (11/15). Interventions: In round 1, open-ended questions were posed relating to potential scope of practice for ‘ultrasound imaging in spasticity management’; (specifically relating to ultrasound image guided injection of Botulinum Toxin) education/competency and governance considerations. In round 2, respondents were asked to rate their level of agreement with the statements generated. Outcome measures: 5-point Likert scale used for rating the statements. Threshold for consensus agreement was set at 70% or above. Results: Three different scopes of practice relating to ultrasound imaging in spasticity management were accepted. The primary scope of practice was the use of ultrasound imaging to guide safe and accurate delivery of botulinum toxin. Relating to this primary scope, 7 competency requirements were agreed relating to areas including image optimization and interpretation, needle visualization and safety. A singular, broad governance statement was generated. Conclusion: Relating specifically to guided injection of botulinum toxin for management of spasticity, we present a scope of practice, competency, and governance framework. These are integrated within a framework approach to provide a mechanism for increased patient access to accurate, safe, and effective focal spasticity treatment. The framework supports focused training routes, greater inter-profession communication and wider clinical community engagement in spasticity management using this modality.
AB - Objective: To establish a scope of practice, competency (through education) and governance framework for ultrasound image guided injection of botulinum toxin in the management of spasticity Design: Delphi study Setting: International, web-based survey Participants: A purposively selected multidisciplinary (physicians, physiotherapists, occupational therapists) panel of experts (n=15) in the use of ultrasound image guided injection of botulinum toxin for management of spasticity. Panel members were predominantly based in the UK (11/15). Interventions: In round 1, open-ended questions were posed relating to potential scope of practice for ‘ultrasound imaging in spasticity management’; (specifically relating to ultrasound image guided injection of Botulinum Toxin) education/competency and governance considerations. In round 2, respondents were asked to rate their level of agreement with the statements generated. Outcome measures: 5-point Likert scale used for rating the statements. Threshold for consensus agreement was set at 70% or above. Results: Three different scopes of practice relating to ultrasound imaging in spasticity management were accepted. The primary scope of practice was the use of ultrasound imaging to guide safe and accurate delivery of botulinum toxin. Relating to this primary scope, 7 competency requirements were agreed relating to areas including image optimization and interpretation, needle visualization and safety. A singular, broad governance statement was generated. Conclusion: Relating specifically to guided injection of botulinum toxin for management of spasticity, we present a scope of practice, competency, and governance framework. These are integrated within a framework approach to provide a mechanism for increased patient access to accurate, safe, and effective focal spasticity treatment. The framework supports focused training routes, greater inter-profession communication and wider clinical community engagement in spasticity management using this modality.
KW - Botulinum Neurotoxins
KW - Delphi method Muscle spasticity
KW - Rehabilitation
KW - Ultrasound Interventional
UR - http://www.scopus.com/inward/record.url?scp=85175868718&partnerID=8YFLogxK
U2 - 10.1016/j.arrct.2023.100299
DO - 10.1016/j.arrct.2023.100299
M3 - Article
AN - SCOPUS:85175868718
SN - 2590-1095
VL - 5
JO - Archives of Rehabilitation Research and Clinical Translation
JF - Archives of Rehabilitation Research and Clinical Translation
IS - 4
M1 - 100299
ER -
