Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 19:54:jrm00320.
doi: 10.2340/jrm.v54.334.

Worldwide Survey of Clinician Practice on use of Adjunctive Therapies Following Botulinum Toxin Injection for Spasticity

Fabienne Schillebeeckx  1 , Patricia B Mills  2 , Alvin Ip  2 , Michal Schinwelski  3 , Joao Eduardo Marten Teixeira  4 , Stephen Ashford  5 , Nicolas Bayle  6 , Elena Chemello  7 , Jorge Jacinto  8 , Meenakshi Nayar  9 , Erika Suzigan  10 , Thierry Deltombe  11
Affiliations

Worldwide Survey of Clinician Practice on use of Adjunctive Therapies Following Botulinum Toxin Injection for Spasticity

Fabienne Schillebeeckx et al. J Rehabil Med. .

Abstract

Objective: Non-pharmacological adjunctive therapies can be used alongside botulinum toxin injection to enhance its efficacy. The objective of this global study was to determine the current practice and perception among clinicians of the use of adjunctive therapies after botulinum toxin injections for the treatment of limb spasticity.

Methods: A questionnaire with 22 questions on clinical practice demographics, self-reported use and clinician opinion on barriers to the use of complementary therapies, and priorities for future research was translated into 7 languages and distributed worldwide through national and international professional associations concerning (neuro)rehabilitation.

Results: A total of 527 clinicians from 52 countries responded to the survey. Most commonly used physical interventions were: active exercise programmes at home (81%), stretching programmes at home (81%), and splinting (70%), followed by active movement exercises (65%) and within 30 min of botulinum toxin injection and constraint induced movement therapy (63%). The main barriers reported by clinicians to provision of these interventions were clinicians' lack of time, limited financial resources, and lack of evidence. Future research should focus primarily on immediate active movement exercises and passive stretching.

Conclusion: Worldwide, clinicians often recommend adjunctive therapies after a botulinum toxin injection to reduce spasticity. The most commonly used physical interventions among clinicians were active exercises at home, stretching at home, and splinting. Lack of evidence, time and financial constraints were identified as barriers to providing these interventions.

PubMed Disclaimer

Conflict of interest statement

FS has received honoraria from Allergan and Merz, MS has received honoraria from Allergan, SA has received honoraria and grant funding from Ipsen and honoraria from Allergan and Merz. JJ has received honoraria from Ipsen, Merz and Abbvie/Allergan for services as speaker, scientific advisor, researcher, and trainer. TD has received grants from Allergan and Merz. AI, MN, JM, NB, EC, MN, ES and PM have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Specialties of clinicians who responded to the survey, and proportions of respondents in high- and low/middle-income countries.
Fig. 2
Fig. 2
Future research priorities regarding adjunctive therapies following botulinum toxin injection for spasticity reported by clinicians in high- and low/middle-income countries. CIMT: Constrained Induced Movement Therapy, ESWT: Extracorporeal Shockwave Therapy, FES: Functional Electrical Stimulation, TENS: Transcutaneous electrical nerve stimulation.
See this image and copyright information in PMC

References

    1. Baude M, Nielsen J, Gracies JM. The neurophysiology of deforming spastic paresis: a revised taxonomy. Ann Phys Rehabil Med 2019; 62: 426–430. - PubMed
    1. Wissel J, Ward A, Erztgaard P, Bensmail D, Hecht M, Lejeune Tet al. European Consensus table on the use of Botulinum Toxin Type A in adult spasticity. J Rehab Med 2009; 41: 13–25. - PubMed
    1. Jacinto J, Varriale P, Pain E, Lysandropoulos A, Esquenazi A. Patient perspectives on the therapeutic profile of botulinum neurotoxin type A in spasticity. Front Neurol 2020; 7: 11 - PMC - PubMed
    1. Mills P, Finlayson H, Sudol M, O’Connor R. Systematic review of adjunct therapies to improve outcomes following botulinum toxin injection for treatment of limb spasticity. Clin Rehabil 2016; 30: 537–548. - PubMed
    1. Picelli A, Santamato A, Chemello E, Cinone N, Cisari C, Gandolfi Met al. Adjuvant treatments associated with botulinum toxin injection for managing spasticity : an overview of the literature. Ann Phys Rehabil Med 2019; 62: 291–296. - PubMed

MeSH terms

Substances