Chung Tae Mo, Jacinto Luis Jorge, Colosimo Carlo, Bhatia Kailash P, Tiley Julie, Bhidayasiri Roongroj
Faculty of Medicine, Institute of Physical Medicine and Rehabilitation, University of São Paulo, São Paulo, Brazil.
Serviço de Reabilitação de adultos, Centro de Medicina de Reabilitacao do Alcoitão, Alcabideche, Portugal.
Front Neurol. 2020 Sep 16;11:570671. doi: 10.3389/fneur.2020.570671. eCollection 2020.
Botulinum toxin-A (BoNT-A) is an effective treatment for cervical dystonia (CD) and spastic paresis (SP), but it requires in-depth knowledge of anatomy and injection techniques. The Ixcellence Network® is an educational programme to provide neurology, neuropaediatrics, and physical medicine and rehabilitation (PMR) specialists with access to best clinical practices and innovations regarding SP and CD management with BoNT-A. To assess the benefits of such educational programmes and identify unmet needs, a multidisciplinary scientific committee designed INPUT (INjection Practice, Usage & Training), an international multicentric survey describing training and practices among this trained and experienced population. A self-completed questionnaire was sent online to 553 trainees and 14 trainers from the Ixcellence Network®. Among the 131 respondents, 92% specialized in PMR (48%) or neurology (44%), with a mean experience of 15.5 years in their clinical fields and 10.9 years of BoNT-A injection. Most of them (98%) reported having received training before performing their first BoNT-A injection and attending specific courses on how to perform it without any instrumental guidance (76%), and with ultrasound (73%), electrical stimulation (44%) or electromyography (41%). In terms of practices, 92% of respondents reported using at least one guidance technique while injecting, with ultrasound being the most used technique (48%). Attending specific courses was significantly associated with greater self-confidence and use, e.g. for injection with ultrasound, mean self-confidence, on a scale from 1 (not confident) to 10 (fully confident), was 7.9 for trained respondents (vs 4.0 for untrained respondents, < ) of whom 70% stated that they used this technique regularly or systematically (vs. 11% of untrained healthcare professionals (HCPs), < ). Moreover, 84% of respondents reported having trained colleagues, residents or fellows through theoretical (70%) or practical teaching in individuals (80%) or in small groups (65%). Overall, 86% of respondents reported a notable increase over the past 5 years of the number of patients treated with BoNT-A. INPUT is the first international survey describing training and practices in SP and CD management of physicians who attended a dedicated educational programme. The results highlighted the importance of training for self-confidence, and the use of specific techniques and new approaches.
肉毒杆菌毒素A（BoNT-A）是治疗颈部肌张力障碍（CD）和痉挛性轻瘫（SP）的有效方法，但需要深入了解解剖学和注射技术。Ixcellence Network®是一项教育计划，旨在为神经科、神经儿科以及物理医学与康复（PMR）专家提供有关使用BoNT-A治疗SP和CD的最佳临床实践和创新方法。为了评估此类教育计划的益处并确定未满足的需求，一个多学科科学委员会设计了INPUT（注射实践、使用与培训），这是一项国际多中心调查，描述了这一训练有素且经验丰富人群的培训和实践情况。一份自我填写的问卷通过网络发送给了Ixcellence Network®的553名学员和14名培训师。在131名受访者中，92%的人专长于PMR（48%）或神经科（44%），在临床领域的平均经验为15.5年，注射BoNT-A的平均经验为10.9年。他们中的大多数人（98%）报告在首次注射BoNT-A之前接受过培训，并参加过关于如何在没有任何器械指导的情况下进行注射的特定课程（占76%），以及使用超声（占73%）、电刺激（占44%）或肌电图（占41%）的课程。在实践方面，92%的受访者报告在注射时至少使用一种指导技术，其中超声是最常用的技术（占48%）。参加特定课程与更强的自信心和更多的使用显著相关，例如对于超声引导注射，在从1（不自信）到10（完全自信）的量表上，接受培训的受访者的平均自信心为7.9（未接受培训的受访者为4.0，<），其中70%的人表示他们经常或系统地使用这种技术（未接受培训的医疗保健专业人员（HCP）为11%，<）。此外，84%的受访者报告通过理论教学（占70%）或个人（占80%）或小组（占65%）的实践教学培训过同事、住院医师或研究员。总体而言，86%的受访者报告在过去5年中接受BoNT-A治疗的患者数量显著增加。INPUT是第一项描述参加专门教育计划的医生在SP和CD管理方面的培训和实践的国际调查。结果突出了培训对于自信心、特定技术和新方法使用的重要性。
