Williams Gavin, Olver John, de Graaff Stephen, Singer Barbara J
Epworth Monash Rehabilitation Medicine Unit, Richmond, Victoria, Australia.
Aust Occup Ther J. 2012 Aug;59(4):257-64. doi: 10.1111/j.1440-1630.2012.01027.x.
Recently, the European Journal of Neurology published international consensus statements for the assessment, treatment and aftercare associated with the use of botulinum neurotoxin type A. This survey examined current allied health practice in relation to botulinum neurotoxin type A use in Australia in the light of these guidelines.
An electronic questionnaire was distributed to members of neurology groups of the Australian Physiotherapy Association and Occupational Therapy Australia. The questionnaire explored assessment processes used, familiarity with pharmaceutical benefits scheme indications for botulinum neurotoxin type A use, goal setting and outcome measurement, follow-up therapy and access to spasticity management services.
The 123 survey respondents (81 from the Australian Physiotherapy Association - response rate 16.2%, 42 from Occupational Therapy Australia - response rate 6.4%) reported that focal spasticity was a major problem for which botulinum neurotoxin type A was a primary intervention. The Tardieu scale was more frequently used than the modified Ashworth scale (82% vs. 48%). Most therapists (76.3%) reported being confident diagnosing spasticity and its functional implications (84.2%), but fewer were confident discussing referral for botulinum neurotoxin type A with doctors (56.1%). Goals were set in conjunction with the client (93.6%). Barriers to injection and adjunctive therapy (motor training etc.) included waiting times for botulinum neurotoxin type A injection, access to specialist adjunctive therapists and referral for treatment.
Allied health practitioners in Australia report clinical practice to be closely aligned with international guidelines for the use of botulinum neurotoxin type A in adult spasticity. Therapist confidence in advocating for botulinum neurotoxin type A injection, consistent use of objective measures of spasticity and treatment outcomes and barriers to providing adjunctive therapy need to be addressed.
最近，《欧洲神经病学杂志》发表了关于A型肉毒杆菌神经毒素使用的评估、治疗及后续护理的国际共识声明。本调查根据这些指南审视了澳大利亚目前在使用A型肉毒杆菌神经毒素方面的相关健康护理实践。
向澳大利亚物理治疗协会和澳大利亚职业治疗协会的神经学小组成员发放了电子问卷。该问卷探讨了所使用的评估流程、对A型肉毒杆菌神经毒素使用的药物福利计划适应症的熟悉程度、目标设定和结果测量、后续治疗以及获得痉挛管理服务的情况。
123名受访者（81名来自澳大利亚物理治疗协会，回复率为16.2%；42名来自澳大利亚职业治疗协会，回复率为6.4%）报告称，局灶性痉挛是一个主要问题，A型肉毒杆菌神经毒素是主要的干预手段。与改良Ashworth量表相比，Tardieu量表的使用频率更高（82%对48%）。大多数治疗师（76.3%）报告称有信心诊断痉挛及其功能影响（84.2%），但较少有人有信心与医生讨论A型肉毒杆菌神经毒素的转诊事宜（56.1%）。目标是与患者共同设定的（93.6%）。注射和辅助治疗（运动训练等）的障碍包括A型肉毒杆菌神经毒素注射的等待时间、获得专科辅助治疗师的机会以及治疗转诊。
澳大利亚的相关健康护理从业者报告称，临床实践与成人痉挛中使用A型肉毒杆菌神经毒素的国际指南密切一致。需要解决治疗师在倡导A型肉毒杆菌神经毒素注射方面的信心、痉挛和治疗结果客观测量方法的一致使用以及提供辅助治疗的障碍等问题。
