Table IV.
Survey results in terms of agreement with the proposed algorithm
| Survey questions | Agree, n (%) | Neutral, n (%) | Disagree, n (%) | Reasons for disagreement |
|---|---|---|---|---|
| Distribution of disabling spasticity | ||||
| I consider patients with multi-segmental or generalized disabling spasticity refractory to oral drug treatment the best candidates for ITB treatment. | 67 (87.0) | 7 (9.1) | 3 (3.9) | Some responders stated that in patients with generalized spasticity the high doses of baclofen could lead to listlessness, severe motor slowdown and weakness, as well as to some side-effects; others consider ITB the therapy of choice for patients with spasticity in both legs, but not necessarily multi-segmental or generalized. |
| I consider patients with focal or segmental disabling spasticity the best candidates for BoNT treatment. | 74 (96.1) | 2 (2.6) | 1 (1.3) | One responder stated that other treatments could be considered. |
| I consider patients with unilateral disabling spasticity affecting lower extremities only as good candidates for ITB treatment. | 10 (13.0) | 29 (37.7) | 38 (49.4) | Some responders stated that this case is a focal/segmental spasticity, therefore ITB is not the therapy of choice as per current guidelines; others confirmed that they treat these patients with BoNT or other therapeutic alternative than ITB. |
| I consider patients with bilateral disabling spasticity affecting lower extremities only as good candidates for ITB treatment. | 64 (83.1) | 11 (14.3) | 2 (2.6) | One responder stated that the decision on treatment depends on ambulatory capacity of patients. |
| I consider patients with unilateral or bilateral disabling spasticity affecting both upper and lower extremities as good candidates for ITB treatment. | 52 (67.5) | 22 (28.6) | 3 (3.9) | Some responders expressed concerns about negative effects of ITB on the healthy extremity and the trunk/respiratory muscles; others would recommend ITB only in case of bilateral spasticity. |
| I consider patients with unilateral disabling spasticity affecting lower extremities and back and/or abdominal muscles as good candidates for ITB treatment. | 35 (45.5) | 35 (45.5) | 7 (9.1) | Some responders expressed concerns about negative effects of ITB on the healthy side and postural muscles (worsening balance); others recommend BoNT as first option in case of unilateral spasticity. |
| I consider patients with bilateral disabling spasticity affecting lower extremities and back and/or abdominal muscles as good candidates for ITB treatment. | 74 (96.1) | 3 (3.9) | 0 (0.0) | None. |
| I consider patients with bilateral disabling spasticity affecting upper extremities only more appropriate candidates for BoNT treatment than ITB. | 69 (89.6) | 8 (10.4) | 0 (0.0) | None. |
| Combined therapy | ||||
| Combined ITB and BoNT treatments should be proposed: in case of generalized or multi-segmental disabling spasticity and patient’s goals not fully achieved with ITB only. | 69 (89.6) | 0 (0.0) | 8 (10.4) | None reported. |
| Combined ITB and BoNT treatments should be proposed: in case of generalized or multi-segmental disabling spasticity affecting lower limbs and jaw and/or neck. | 44 (57.1) | 0 (0.0) | 33 (42.9) | None reported. |
| If a patient doesn’t fully reach their rehabilitation goals with BoNT therapy plus rehabilitation/orthosis, I consider him/her for ITB. | 40 (51.9) | 30 (39.0) | 7 (9.1) | Some responders stated that in these cases they would prefer oral medications or other conservative measure first; others stated that they would consider surgical procedures if contracture was evident. |
| Patient preference | ||||
| I consider patient/caregiver preferences regarding treatment option at every stage of the treatment decision process (shared decision approach). | 74 (96.1) | 3 (3.9) | 0 (0.0) | None. |
ITB: intrathecal baclofen; BoNT: botulinum toxin.