A survey of the current practice of intramuscular Botulinum toxin injections for hemiplegic shoulder pain in the UK

Holmes, Richard J. and Connell, Louise A. (2019) A survey of the current practice of intramuscular Botulinum toxin injections for hemiplegic shoulder pain in the UK. Disability and Rehabilitation, 41 (6). pp. 720-726. ISSN 0963-8288

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Abstract

Purpose:To describe the current UK practice for the use of intramuscular Botulinum Toxin type A injections to treat hemiplegic shoulder pain. Method:A UK-based cross-sectional study using an online survey. Participants (n = 68) were medical and non-medical practitioners recruited via the membership of the British Society for Rehabilitation Medicine and the British Neurotoxin Network. Data was analysed using descriptive statistics and content analysis. Results: The majority of respondents would consider Botulinum Toxin type A for hemiplegic shoulder pain (86.8%), though most of these respondents inject for this goal infrequently (83.1%). Pectoralis major was most commonly selected to achieve this goal. Barriers to this intervention included difficulties determining the cause of pain (29.4%), difficulty isolating muscles (27.9%), and a lack of evidence (25%). The doses reported regularly deviated from guidelines and a substantial range in the volumes suggested was observed. Clinicians were mostly reliant on unstandardised measures to assess outcomes. Conclusions: Current UK practice of Botulinum Toxin type A injections for hemiplegic shoulder pain associated with spasticity is highly variable. There are large gaps between current practice and available evidence with regards to muscle selection and doses used. A number of areas for further investigation have been identified to progress current understanding of this intervention.Implications for rehabilitation There are wide variations in practice for this complex intervention and clinicians should consider that their individual decision-making could be based on their own beliefs rather than available evidence. Pectoralis major is most commonly injected to treat hemiplegic shoulder pain, but further evaluation is required to address whether it is the most effective. Clinicians most often use a limitation of shoulder abduction and external rotation, flexor patterning of the upper limb, and pain on passive movement to identify when hemiplegic shoulder pain is due to spasticity over other causes. Further research is needed to identify which patients are most likely to benefit from this intervention and at what stage post-stroke its use is most optimal.

Item Type:
Journal Article
Journal or Publication Title:
Disability and Rehabilitation
Additional Information:
Publisher Copyright: © 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group.
Uncontrolled Keywords:
/dk/atira/pure/subjectarea/asjc/2700/2742
Subjects:
?? botulinum toxinhemiplegic shoulder painpost-stroke shoulder painspasticitystrokesurveyrehabilitation ??
ID Code:
217041
Deposited By:
Deposited On:
27 Mar 2024 14:25
Refereed?:
Yes
Published?:
Published
Last Modified:
19 Sep 2024 10:23