THERAPY INFLUENCES GOAL ATTAINMENT FOLLOWING BOTULINUM NEUROTOXIN INJECTION FOR FOCAL SPASTICITY IN ADULTS WITH NEUROLOGICAL CONDITIONS

Williams G.^1,2, Moore E.J.^1,2, Olver J.³, Bryant A.², McKenzie D.⁴

¹Epworth HealthCare, Physiotherapy Rehabilitation, Richmond, Australia, ²The University of Melbourne, Physiotherapy, Parkville, Australia, ³Epworth Monash Rehabilitation Unit, Rehabilitation Medicine, Richmond, Australia, ⁴Epworth HealthCare, Research Institute, Richmond, Australia

Background: The international consensus statements for the use of botulinum neurotoxin A (BoNT-A) treatment in adults suggest that Physiotherapy and Occupational Therapy should be provided in conjunction with the BoNT-A injection in order to optimize rehabilitation outcomes. Despite this recommendation, the evidence for the independent contribution of adjunctive therapies on patient outcomes has not been established.

Purpose: The aim of this project was to investigate the influence of physiotherapy and occupational therapy on outcome, in terms of goal attainment, following BoNT-A injection for focal spasticity in adults with neurological conditions.

Methods: This prospective observational study was conducted on a group of eligible participants attending the Epworth HealthCare Spasticity Clinic. The 31 adults were provided with a prescribed program from an experienced clinician following their BoNT-A injection designed to maximise their outcome. The rate of adherence to the prescribed program was examined after three months to determine if adherence to therapy improved rehabilitation outcomes as measured by goal attainment. Clustered logistic regression, allowing for multiple goals per participant was used.

Results: The 31 participants had a total of 76 goals. Active indications for treatment made up the majority of the goals (80.30%). Goals were achieved in 43 out of the 76 cases (56.60%; 95% CI = 42.40-69.80%). Therapy adherence was significantly associated with goal attainment (OR = 1.018, p=0.033, 95% CI=1.001 to 1.035). A higher adherence to therapy increased the odds of goal achievement for active indications but not for passive indications. Suggesting a statistical interaction between active/passive and adherence to therapy (difference between the odds p=0.006).

Conclusion(s): Therapy adherence was significantly associated with goal attainment. Active indications were most reliant on the prescription of adjunctive therapies following BoNT-A injection for focal spasticity in adults with neurological conditions. There was no statistically significant interaction between the location of the injection and adherence to therapy program on goal attainment.

Implications: Further larger scale investigations into the relationship between adjunctive therapy and goal attainment, for the different indications for BoNT-A injection, are required prior to the implementation of guidelines for therapy programs following BoNT-A injection. However, t There are five main areas that may assist clinicians working in this specialist area which include the following: - The provision of skilled therapy for the active indications for BoNT-A injection may be an effective method of optimising rehabilitation outcomes. - Passive goals potentially require more targeted therapy for a shorter period of time to educate carers regarding stretching programs and the application of splints. - More education regarding the need to adhere to more than 60% of the prescribed therapy program following BoNT-A injection for active indications may be beneficial in improving goal attainment within this subgroup. - This study supports suggestions that patients continue to receive benefit from repeat BoNT-A treatments and subsequent prescription.

Funding acknowledgements: There was no financial support for this study.

Topic: Neurology

Ethics approval: Epworth HealthCare Human Research Ethics Committee Study Number 57312. The University of Melbourne Human Ethics Advisory Group ID: 1339895.

All authors, affiliations and abstracts have been published as submitted.