Abstract

Objective: Residency programs in the United States lack the necessary training for physicians to confidently and competently inject botulinum neurotoxin (BoNT) and manage complex spasticity patients. This creates an unmet need for spasticity patients who could benefit from BoNT injections. This study measured the impact of additional BoNT injection and spasticity management training on post-residency medical practice. Design: Graduates from our Physical Medicine and Rehabilitation residency from 2008 to 2024 were surveyed. Responses were collected from physicians who had residency BoNT injection and spasticity management training (RT) and compared to fellowship BoNT injection and comprehensive spasticity management training (FT). Results: 15 RT and 14 FT physicians completed the survey and were evaluated using descriptive statistics. Spasticity and dystonia treatments comprised an average of 10% of the RT and 62% of the FT clinical practice. BoNT injections involved 5% of the RT practice and 52% of the FT practice. Conclusion: Disabling spasticity is undertreated in this country, partly due to a shortage of training programs for physicians to become skilled and confident at injecting BoNT and comprehensive spasticity management. FT programs can help meet this unmet need by increasing the number of physicians who can provide specialized BoNT injections and spasticity management.

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