Management of stroke patients submitted to botulinum toxin type A therapy: a Delphi survey of an Italian expert panel of specialist injectors.

Spasticity is a common disabling symptom of several neurological conditions including stroke. Botulinum toxin type A (BTX-A) injection represents the gold standard therapy for focal spasticity. Post-stroke management of patients receiving BTX-A therapy has been variously investigated, but general agreement on how and when to implement rehabilitation is lacking.
To perform a national survey of experts on the most appropriate rehabilitation procedures after BTX-A therapy for the focal treatment of spasticity.
The study employed the Delphi technique through the COSMO project (Consensus on Post-Injection Management in Post-stroke Spasticity).
Italian neurologists and physiatrists with experience in BTX-A therapy were selected to participate in the survey. Their anonymous opinions on key issues in treatment strategies in post-stroke spasticity were collected in three sequential rounds facilitated by a web platform. Consensus on a given issue was defined as agreed opinion by at least 66% of the survey participants.
In all, 44 Italian experts were involved. Positive consensus was reached on the need to start rehabilitation during the first week after BTX-A injection therapy, with a rehabilitation program comprising both stretching combined with electrical stimulation and exercise therapy. Functional surgery may be considered only after 12-24 months in cases of BTX-A therapy failure. The use of commercial or custom-made orthoses in selected cases was recommended. The appropriate time interval between two BTX-A injections is 3-6 months, and clinical assessment should be performed 1 month after injection.
The results of this national survey confirm that clinical experts on the use of BTX-A therapy for spasticity after stroke agree on the need to initiate rehabilitation treatment immediately after BTX-A injection: muscle stretching exercises, eventually combined with neuromuscular electrical stimulation, may enhance the effect of BTX-A therapy. Outcome after BTX-A therapy should be assessed at repeated follow-up visits.
This expert panel survey can provide guidance for clinicians in the assessment of patients treated with BTX-A therapy.
AuthorsM Franceschini, M Iocco, F Molteni, A Santamato, N Smania,
JournalEuropean journal of physical and rehabilitation medicine (Eur J Phys Rehabil Med) Vol. 50 Issue 5 Pg. 525-33 (Oct 2014) ISSN: 1973-9095 [Electronic] Italy
PMID24963604 (Publication Type: Journal Article)
Chemical References
  • Neuromuscular Agents
  • Botulinum Toxins, Type A
  • Attitude of Health Personnel
  • Botulinum Toxins, Type A (therapeutic use)
  • Delphi Technique
  • Disease Management
  • Humans
  • Italy
  • Muscle Spasticity (drug therapy, etiology, rehabilitation)
  • Neuromuscular Agents (therapeutic use)
  • Practice Patterns, Physicians'
  • Stroke (complications, rehabilitation)

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