title: Upper limb spasticity management for patients who have received Botulinum Toxin A injection: Australian therapy practice.
abstract: OBJECTIVE
  To describe Australian physiotherapy and occupational therapy practice for patients who receive upper-limb Botulinum Toxin-A (BoNT-A).
  
  
  METHODS
  Anonymous online survey asking about practice experience. Convenience sample of 128 BoNT-A experienced occupational therapists and physiotherapists.
  
  
  RESULTS
  The primary work setting was multidisciplinary inpatient or outpatient rehabilitation services where therapists had automatic referral to BoNT-A patients. Patients expected BoNT-A to improve functional movement, reduce hypertonicity, increase passive range, reduce pain, improve appearance and hand hygiene. Most patients were injected in multidisciplinary public hospital clinics and had median 2 pre-injection (range 0-30) and 8 post-injection (range 0-50) therapy sessions. Biceps, flexor digitorum profundus/superficialis and brachoradialis were most frequently injected. Injectors used therapist assessment information to select sites 68% of the time; only 44% of services had assessment protocols. Standardised therapy assessments examined motor performance, pain and function in that order of frequency. The greater the awareness and perceived relevance of an assessment the more often therapists used it. All therapists set goals, most collaboratively, and these mirrored patient expectations. The most common treatments were stretch, task-specific functional training, strength training and home programmes.
  
  
  CONCLUSIONS
  While trends in Australian assessment, goals and treatment practice were observed, greater consistency could be achieved if therapy practice guidelines existed. The gap is exacerbated by the absence of Australian BoNT-A organisation and process of care spasticity management guidelines. This creates an environment where practice variability is inevitable. Recommendations to improve local service quality are made.
authors: School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia.
authors: Anne
authors: A
authors: Cusick
authors: Natasha
authors: N
authors: Lannin
authors: Bianca Zoe
authors: BZ
authors: Kinnear
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D001315:Australia; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000534:rehabilitation*; D009788:Occupational Therapy / Q000379:methods*; D010147:Pain Measurement; D012047:Rehabilitation Centers; D018570:Risk Assessment; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D034941:Upper Extremity; D055815:Young Adult
chemical_list: D019274:Botulinum Toxins, Type A
keywords: botulinum toxins; muscle spasticity; physical therapy modalities; rehabilitation