title: [Medical care of patients with spasticity following stroke : Evaluation of the treatment situation in Germany with focus on the use of botulinum toxin].
abstract: BACKGROUND
  Upper limb spasticity is a common complication following stroke. Cohort studies found 19% of post-stroke patients had upper limb spasticity at 3 months and 38% of patients at 12 months. For focal spasticity, intramuscular injections of botulinum toxin are indicated. In Germany, it is assumed that patients with the described indication are undersupplied with botulinum toxin.
  
  
  OBJECTIVE
  The aim of the present study is to evaluate the medical care of patients with upper limb spasticity post-stroke with the focus on the use of botulinum toxin as one treatment option.
  
  
  METHODS
  A standardized questionnaire was developed and a postal survey of a representative national random sample of 800 neurologists to capture the actual medical care situation.
  
  
  RESULTS
  The response rate amounted to 37% (n = 292). 59% of the neurologists surveyed had never used botulinum toxin. In total, 87% of neurologists noticed barriers regarding the use of botulinum toxin, where the amount of the doctor's remuneration in 40% and the lack of reimbursement of costs in off-label use in 60% were the most commonly used answers. The achievement of an advanced training in using botulinum toxin was also stated as a general obstacle for resident neurologists.
  
  
  CONCLUSIONS
  Due to a response rate of 37% for the postal survey a selection bias cannot be excluded. Although botulinum toxin is recommended in the national treatment guidelines, many neurologists do not use botulinum toxin. The reasons can be seen from the barriers described.
authors.affiliation: Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Deutschland. Linda.Kerkemeyer@medman.uni-due.de.
authors.forename: L
authors.initials: L
authors.lastname: Kerkemeyer
authors.affiliation: Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Deutschland.
authors.forename: G
authors.initials: G
authors.lastname: Lux
authors.affiliation: Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Walendzik
authors.affiliation: Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Wasem
authors.affiliation: Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Neumann
mesh_terms: D000284:Administration, Oral; D001905:Botulinum Toxins / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005858:Germany; D006801:Humans; D007273:Injections, Intramuscular; D009128:Muscle Spasticity / Q000188:drug therapy*; D009788:Occupational Therapy; D056687:Off-Label Use; D010276:Parasympatholytics / Q000008:administration & dosage; D010348:Patient Care Team; D026741:Physical Therapy Modalities; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D020521:Stroke / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D034941:Upper Extremity
chemical_list: D010276:Parasympatholytics; D001905:Botulinum Toxins
keywords: Botulinum toxins Type A; Evaluation; Standardized survey