title: The use of botulinum toxin type A in the management of adult-onset focal spasticity: a survey of Australian allied health professionals.
abstract: BACKGROUND
  Recently, the European Journal of Neurology published international consensus statements for the assessment, treatment and aftercare associated with the use of botulinum neurotoxin type A. This survey examined current allied health practice in relation to botulinum neurotoxin type A use in Australia in the light of these guidelines.
  
  
  METHODS
  An electronic questionnaire was distributed to members of neurology groups of the Australian Physiotherapy Association and Occupational Therapy Australia. The questionnaire explored assessment processes used, familiarity with pharmaceutical benefits scheme indications for botulinum neurotoxin type A use, goal setting and outcome measurement, follow-up therapy and access to spasticity management services.
  
  
  RESULTS
  The 123 survey respondents (81 from the Australian Physiotherapy Association - response rate 16.2%, 42 from Occupational Therapy Australia - response rate 6.4%) reported that focal spasticity was a major problem for which botulinum neurotoxin type A was a primary intervention. The Tardieu scale was more frequently used than the modified Ashworth scale (82% vs. 48%). Most therapists (76.3%) reported being confident diagnosing spasticity and its functional implications (84.2%), but fewer were confident discussing referral for botulinum neurotoxin type A with doctors (56.1%). Goals were set in conjunction with the client (93.6%). Barriers to injection and adjunctive therapy (motor training etc.) included waiting times for botulinum neurotoxin type A injection, access to specialist adjunctive therapists and referral for treatment.
  
  
  CONCLUSIONS
  Allied health practitioners in Australia report clinical practice to be closely aligned with international guidelines for the use of botulinum neurotoxin type A in adult spasticity. Therapist confidence in advocating for botulinum neurotoxin type A injection, consistent use of objective measures of spasticity and treatment outcomes and barriers to providing adjunctive therapy need to be addressed.
authors.affiliation: Epworth Monash Rehabilitation Medicine Unit, Richmond, Victoria, Australia. gavin.williams@epworth.org.au
authors.forename: Gavin
authors.initials: G
authors.lastname: Williams
authors.forename: John
authors.initials: J
authors.lastname: Olver
authors.forename: Stephen
authors.initials: S
authors.lastname: de Graaff
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Singer
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D020407:Internet; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000534:rehabilitation; D009498:Neurotoxins / Q000008:administration & dosage / Q000627:therapeutic use; D009788:Occupational Therapy / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000592:standards* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires
chemical_list: D009498:Neurotoxins; D019274:Botulinum Toxins, Type A