Ultrasound image guided injection of botulinum toxin for the management of spasticity: A Delphi study to develop recommendations for a scope of practice, competency, and governance framework.
Stephen A Ashford, Gary Morris, Michael J Smith
PMID 38163024WHAT IT FOUND
Experts agreed that ultrasound guidance for botulinum toxin injections in spasticity requires specific competencies in needle visualization and infection control, not full diagnostic sonography.
They recommend a tightly defined scope of practice to facilitate safe, accessible treatment delivery.
Key findings
01All 15 experts agreed that the primary scope of practice involves visualizing the needle and localizing botulinum toxin into the target muscle while avoiding at-risk structures.
02Core competencies achieving 100% consensus included adapting ultrasound settings to optimize imaging, identifying tissue types, applying injection-specific strategies, and adhering to infection control procedures.
03Experts unanimously agreed on a single governance statement requiring practitioners to consider ultrasound imaging governance relevant to their specific country of practice and professional regulator.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Participants were recruited based on botulinum toxin expertise, not phenol or sonographic assessment expertise, which may bias findings against Scopes 2 and 3. The sample was geographically limited to high-income settings in Europe and North America, restricting applicability to other health care systems. The study reports expert consensus, not clinical outcomes, so it does not prove that this framework improves patient safety or efficacy. Only 15 participants were included, which is a small panel for developing broad governance frameworks.
Declared interests
Ethical approval was granted by Cardiff University. No specific funding sources or commercial conflicts of interest were declared in the provided text.
The easy way to misread this
Do not interpret this consensus as evidence that ultrasound guidance improves clinical outcomes or patient safety. This study reports what experts believe should be done; it does not measure whether these recommendations lead to better results for patients.