Canadian Physicians’ Use of Ultrasound in Spasticity Treatment: A National Cross-Sectional Survey

Objective

To identify potential barriers and obstacles preventing clinicians from adopting ultrasound for spasticity management.

Design

A prospective, cross-sectional national survey.

Setting

Web-based platform.

Participants

Thirty-six physicians and surgeons from across Canada.

Interventions

Survey completion.

Main Outcome Measures

The use of ultrasound in clinical spasticity practice, perceived barriers, and risks associated with its implementation.

Results

In total, 36 Canadian physicians and surgeons responded. A total of 91% reported using the US in their practice. Nearly all of them used ultrasonography (US) to guide injections and reported using more than 1 guidance technique for their injections. Less than half of the survey respondents reported using the US for muscle architecture assessment or longitudinal evaluation of muscle echo intensity. A total of 47% of survey respondents reported that they believe there are disadvantages associated with US use in spasticity practice. Disadvantages included increased time requirements resulting in discomfort for the injector and patient, the risk of infection after the procedure, and the risk of needle-stick injury. The most important barrier identified was the increased time demands of US compared with other guidance techniques. Other barriers included a lack of feedback on identifying a spastic muscle compared with electrical guidance techniques, a lack of additional remuneration to complete injections under ultrasound guidance, and a lack of adequate training.

Conclusions

Future educational efforts should address clinicians’ lack of familiarity with US purposes outside of injection guidance. This survey has highlighted the need for a curriculum shift in spasticity education to improve physician's scanning and injection technique, to address concerns about increased time requirements for injecting under ultrasound guidance and to address perceived disadvantages from clinicians.