Understanding Variability in Botulinum Toxin-A Use for CP-Associated Spasticity

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Understanding Variability in Botulinum Toxin-A Use for CP-Associated Spasticity

Understanding Variability in Botulinum Toxin-A Use for CP-Associated Spasticity

You are invited to participate in a brief (≤10 minute) survey regarding your use of botulinum toxin-A (BoNT-A) for lower extremity tone management in individuals with cerebral palsy (CP).

Significant variability exists in neurotoxin treatment patterns across North America, with no clearly dominant protocol regarding indications, dosing, frequency, or outcome assessment. The goal of this survey is to better understand the current landscape of practice and to identify the drivers of variability. These preliminary data will inform the design of future multi-center comparative effectiveness studies and help guide development of best-practice recommendations.

We greatly appreciate your time and expertise. Participation is voluntary. Your responses will be de-identified and analyzed in aggregate, and no individually identifiable information will be reported.

By proceeding with and submitting this survey, you are providing your consent to participate in this research study.

SECTION 1: Provider & Practice Characteristics
1. What is your primary role?
2. Primary specialty training
3. Subspecialty focus (if applicable)
4. Years in practice (post-training)
5. Practice setting
6. Geographic location
7. Approximate percentage of your clinical practice comprised of patients with CP
8. What other disorders make up your clinical practice (please indicate all that comprise more than 10% of your practice)
9. Approximate percentage of your practice that is pediatric (<18 years)
10. Including yourself, how many partners are there in your practice
11. What is your primary compensation model
12. Does your compensation model include financial incentives tied to any of the following (select all that apply)
13. Do you use Botulinum toxin in your clinical practice?
SECTION 2: Patient Selection & Indications
14. Which patients do you typically inject with BoNT-A? (Select all that apply)
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15. Minimum age at which you typically initiate BoNT-A
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16. Primary indications for injection in ambulatory patients (select up to 3)
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17. Primary indications for injection in non-ambulatory patients (select up to 3)
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18. What primarily determines your decision to inject in ambulatory patients?
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19. What primarily determines your decision to inject in non-ambulatory patients?
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20. Which exam findings most influence your decision in ambulatory patients? (Select all)
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21. Which exam findings most influence your decision in non-ambulatory patients? (Select all)
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22. Preferred brand
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23. Does your institution dictate a specific brand
24. Typical dosing strategy in ambulatory patients
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25. Typical dosing strategy in non-ambulatory patients
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26. Typical total dose per session (U/kg) in ambulatory patients
27. Typical total dose per session (U/kg) in non-ambulatory patients
28. Maximum total dose allowed per session in ambulatory patients
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29. Maximum total dose allowed per session in non-ambulatory patients
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30. Typical injection frequency in ambulatory patients
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31. Typical injection frequency in non-ambulatory patients
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32. What primarily drives frequency of repeat injections?
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SECTION 4: Technique & Setting
33. Injection setting
34. If completed in clinic, what alternative methods are used to increase comfort? (select all that apply)
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35. Localization method (select all)
36. Do you routinely perform pre- and post-injection assessments?
37. Outcomes you routinely measure (select all)
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38. In ambulatory patients, success is primarily defined as
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39. In non-ambulatory patients, success is primarily defined as
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40. Which factors most influence your BoNT-A protocol? (Select up to 3)
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41. Do you believe your practice differs from other provider in North America?
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42. Would you be interested in participating in a multicenter comparative effectiveness study of BoNT-A protocols?
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Thank you for your participation. We have no further questions.