118 - Delphi analysis: anatomy and botulinum neurotoxin type A injection training for spasticity and dystonia

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Co-Author(s)

Kimberly G. Heckert, MD

Director, Spacticity Management Fellowship Program; Clinical Associate Professor
Thomas Jefferson University
Philadelphia, Pennsylvania, United States
BB

Bo Biering-Sørensen, MD

Head of Movement Disorder Clinic, Spasticity Clinic and Pain Clinic hos Neurological department
Rigshospitalet Glostrup
Glostrup, Hovedstaden, Denmark
TB

Tobias Bäumer, MD

Neurologist
Institute of Systems Motor Science, University of Lübeck
Lübeck, Schleswig-Holstein, Germany
OK

Omar Khan, MD

Physician
Hotel Dieu Shaver Health and Rehabilitation Centre
St. Catharines, Ontario, Canada
FP

Fernando Pagan, MD

Professor and Vice Chairman, Department of Neurology
Georgetown University, Parkinson Foundation Center of Excellence
Washington, District of Columbia, United States
MP

Mitchell H. Paulin, MD

Director
The Center for Tone Management, Rehabilitation Associates of the Main Line
Paoli, Pennsylvania, United States
TS

Todd P. Stitik, MD

Professor
Rutgers New Jersey Medical School
Newark, New Jersey, United States

Presenting Author(s)

Monica Verduzco-Gutierrez, MD (she/her/hers)

Professor and Chair of Rehabilitation Medicine
UT Health San Antonio
San Antonio, Texas, United States

Co-Author(s)

Rajiv N. Reebye, MD

Clinical Assoc Professor, Director of the New Westminster Rehabilitation Medicine Spasticity Clinic
University of British Columbia
Vancouver, British Columbia, Canada

Objectives: Effective treatment with botulinum neurotoxin type A (BoNT-A) injection in spasticity and dystonia requires in-depth knowledge of muscle anatomy and injection-guidance methods, such as ultrasound (US). However, there are no global, standardized best practices to guide training program development in these areas. Therefore, the aim of this research is to provide expert consensus on best practices for anatomy teaching and training on US-guided BoNT-A injection for specialists who treat patients with spasticity and dystonia.

Design: Nine experts (three neurologists; six physical medicine and rehabilitation physicians) took part in a three-round modified Delphi process. In Round 1, experts met face-to-face in an advisory board meeting to generate a series of initial best-practice statements. Rounds 2 and 3 were voting rounds in which experts provided anonymous feedback on the statements via self-administered online questionnaires.

Results: In Round 1, experts generated 16 statements describing best practices for designing training programs on US-guided BoNT-A injection that incorporate anatomy teaching. By the end of Round 3, experts had reached a consensus on 15 statements, from among which three core principles for designing effective training programs were identified. First, training should be tailored to the target audience’s needs by considering how existing educational programs and trainees’ current competencies could be improved. Second, instructors must align to ensure consistent approaches, messaging, and nomenclature usage over time and between regions. Third, training programs should be simple, adaptable, and hands-on to aid engagement and learning. Experts also reached consensus on best-practice principles for other elements of training program design, such as objectives, content, eligibility criteria, and assessment.

Conclusions: Using these best-practice principles to develop effective, standardized programs for anatomy and US-guided BoNT-A injection training could enhance global collaboration between experts, enabling more physicians to treat spasticity and dystonia and ultimately improving patient outcomes.