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. 2023 Sep 29;5(4):100299.
doi: 10.1016/j.arrct.2023.100299. eCollection 2023 Dec.

Ultrasound image guided injection of botulinum toxin for the management of spasticity: A Delphi study to develop recommendations for a scope of practice, competency, and governance framework

Stephen A Ashford  1 , Gary Morris  2   3 , Michael J Smith  2
Affiliations

Ultrasound image guided injection of botulinum toxin for the management of spasticity: A Delphi study to develop recommendations for a scope of practice, competency, and governance framework

Stephen A Ashford et al. Arch Rehabil Res Clin Transl. .

Abstract

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.

Keywords: Botulinum Neurotoxins; Delphi method Muscle spasticity; Rehabilitation; Ultrasound Interventional.

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Figures

Image, graphical abstract
Graphical abstract
Fig 1
Fig 1
PoCUS framework triangle; adapted for UI in spasticity management (20). A framework for PoCUS. Concept by Dr Mike Smith (Cardiff University UK), created by Dan Molloy (freshwater.media). Copyright 2021 Dr Mike Smith
Fig 2
Fig 2
Conducting and Reporting of Delphi Studies (CREDES) study flow diagram.
See this image and copyright information in PMC

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