Online monitoring of focal spasticity treatment with botulinum toxin in people with chronic stroke or hereditary spastic paraplegia: a feasibility study

Abstract

Objective: To investigate the feasibility and usability of an online spasticity monitoring tool amongst people with hereditary spastic paraplegia or chronic stroke receiving botulinum toxin treatment, and their healthcare providers. Methods: Mixed methods cohort study, measuring recruitment success and adherence to the monitoring in 3 rehabilitation institutions. In addition, the System Usability Scale (SUS) and interviews with patients and their healthcare providers were used for quantitative and qualitative analysis, respectively. A deductive directed content analysis was used for qualitative evaluation. Results: Of the 19 persons with hereditary spastic paraplegia and 24 with stroke who enrolled in the study, recruitment success and adherence were higher amongst people with hereditary spastic paraplegia compared with stroke. Usability was found “marginal” by rehabilitation physicians and “good” by patients and physical therapists (SUS scores 69, 76, and 83, respectively). According to all participant groups, online monitoring potentially contributes to spasticity management if it is tailored to the actual needs and capabilities of patients, and if it can easily be integrated into the daily/working routines of all users. Conclusion: Online monitoring of spasticity in people with hereditary spastic paraplegia or stroke receiving treatment with botulinum toxin may be feasible, provided that the monitoring tool is tailored to the needs of all users. LAY ABSTRACT This study investigated recruitment success and adherence to an online spasticity monitoring tool amongst people with hereditary spastic paraplegia or stroke and their healthcare providers. Usability was evaluated with a questionnaire and interviews. Twenty-four persons with stroke and 19 with hereditary spastic paraplegia participated through 3 rehabilitation institutions. The hereditary spastic paraplegia group was more willing to participate and their adherence to online monitoring was higher than the stroke group. Usability was scored “marginal” by rehabilitation physicians, and “good” by people with spasticity and their physical therapists. The interviews showed that online monitoring may contribute to better spasticity management if it is tailored to the actual needs and capabilities of people with spasticity, and if it can easily be integrated into daily/working routines of all users. Online monitoring of spasticity seems to be feasible. Tailoring the monitoring tool to patients’ needs and capabilities, and the professionals’ routines may further improve feasibility and usability.

Keywords

• stroke
• hereditary spastic paraparesis
• spasticity
• feasibility studies
• internet-based intervention
• electronic health record