Patient Registry of Spasticity Care World: Data Analysis Based on Physician Experience.

This was an observational registry without random assignment or a control group, so differences between physician groups may reflect patient mix, site practice, or other unmeasured factors. Physicians chose the botulinum toxin product, dose, muscles, and injection technique, and the study did not control these choices, so it cannot separate the contribution of any single treatment component. Only participants with available data were analysed, and 112 missing follow-up data were reported. The Ashworth Scale was used to signify a biologic effect, not as a clinical outcome measure. Follow-up was limited to 6 months, and the authors state this may be too short to show functional change in a chronic population. Sample sizes differed across goal types, which may affect the power of Goal Attainment Scaling results. Practice setting and equipment access were not stratified, so differences in localization technique may reflect access rather than physician preference. Availability and reimbursement of botulinum toxins varied internationally, so the detailed data mainly represent patients treated with onaBoNTA.

The authors stated that no conflicts of interest were reported by the authors or by any individuals in control of the content.

Do not read the differences as proof that more experienced physicians produce better patient outcomes. The study was observational, patients received onaBoNTA, aboBoNTA, and incoBoNTA with physician-selected doses and techniques, and Ashworth scores were used to indicate a biologic effect rather than a clinical outcome.