SPECIAL INTEREST REPORT PLATFORM PRESENTATION

DEVELOPMENT OF GUIDELINES FOR INJECTION OF BOTULINUM TOXIN BY PHYSIOTHERAPISTS IN THE U.K. Robertson A¹, Power T², Ashford S³; ¹Mid Yorkshire Hospitals NHS Trust, UK. ²University College of Ripon and St Johns at York, UK. ³Northwick Park Hospital, London

PURPOSE: In 2000 there were 2 extended scope practitioner physiotherapists trained to inject botulinum toxin in the U.K. Their practice and competencies were developed in the workplace. As the number of injectors increased around the U.K. it became clear that a validated, post-graduate course with supporting guidelines was required. A collaboration between the NHS, CSP, clinical interest groups, Academic institutions and the toxin manufacturers resulted in the formation of the UK adult physiotherapy spasticity forum which co-ordinated development of this extension of scope of practice. RELEVANCE: Extending the scope of practice of physiotherapy can be daunting but with support and a project management approach it was possible to deliver changes in practice on a national level. More and more, physiotherapists are in positions to use their core skills and sometimes extended scope skills to deliver care in different ways. DESCRIPTION: The guidelines were developed by reviewing the available literature and writing a document that would support safe, effective practice within legal constraints and to the satisfaction of all contributing parties. The post-graduate courses were developed by separate academic institutions via a link to the chair of the UK adult spasticity physiotherpay forum to encourage consistency of approach. These are at masters level and have run succesfully for the last 2 years. EVALUATION: Over the course of 3 years (2003-2006) the group wrote an evidence based set of national guidelines, supported 2 national conferences and supported the development of post-graduate injection courses for physiotherapists and occupational therapists at 2 Universities. The Royal College of Physicians have approached the forum to discuss contributing to the revision of their Botulinum Toxin guidelines. CONCLUSIONS: This development represents an extension of scope of practice in terms of administration of Botulinum toxin for adult and paediatric spasticty. In the U.K. this represents a small, specialised but expanding field. IMPLICATIONS: Practice in non-U.K. countries could move in this direction providing the mechanisms for the botulinum toxin administration are in place. The development of post-graduate modules and the evidence based guidelines have gone a long way to demonstrate the development of the physiotherapists role in this area represents effective and safe practice with clinical governance at the core. Physiotherapists are ideally placed with anatomical, movement analysis and goal oriented approaches to deliver this intervention safely and effectively. KEYWORDS: Extended scope of practice. Botulinum toxin injections. Adult spasticity. Paediatric spasticity. FUNDING ACKNOWLEDGEMENTS: The guideline was developed with the support of an unrestricted educational grant from Allergan. CONTACT: adrian.robertson@midyorks.nhs.uk