Development of a measure of therapy provision for spasticity management in the paretic lower limb – the Leg Therapy recording Schedule (LegTS)

Abstract

Purpose: In rehabilitation studies, it is critical to understand the constituents of interventions. First, to enable replication of the work and second, to identify what treatments work best. The development of a tool to describe and quantify therapy interventions in the context of focal spasticity management is presented.

Methods: Potential intervention categories were identified from: (a) retrospective analysis of prospectively collected data from a cohort of patients (n = 62) receiving physical interventions in the context of botulinum toxin (BoNT) injection for leg spasticity and (b) cognitive de-briefing with Patient and Carer Advisory Group (PCAG) of patient and carer dyads (n = 8). Item reduction was achieved through consultation with a purposively-selected group of physiotherapists and occupational therapists (n = 16) in a two-round Delphi process. This was followed by review of findings by PCAG members.

Results: A list of 24 possible therapy categories were identified and then reduced, resulting in a tool with two domains: (1) postural management; four categories and (2) exercise and retraining; four categories. The Leg Therapy recording Schedule (LegTS) wording and presentation were refined for clinical and research use.

Conclusions: The LegTS is designed to record therapy interventions for the paretic lower limb in the context of spasticity intervention. Content and face validity have initially been addressed within the development process.

Implications for Rehabilitation

• Clinicians need to understand intervention effectiveness, and to do so, it is critical to capture all the components of a complex intervention.

• In clinical practice or research, patient experience measures are required to capture the complexity of intervention provided and monitor intervention effectiveness on a case by case basis.

• Clinicians involved in rehabilitation and management of focal spasticity in the leg can use the Leg Therapy recording Schedule (LegTS) to enable an understanding of the entirety of the intervention package provided.

Keywords:

• Patient experience
• lower limb
• physiotherapy
• Delphi
• exercise

Acknowledgements

We would like to thank the Project Advisory Group and colleagues who participated in the Delphi consultation and in the development of this work. In particular, we could like to thank: Sam Orridge, Alison Gomes da Silva, Helen Johnston, Denise Hancock, Hilary Rose, Beverley Fielding, Sarah Brogden, Hugh Brunskill, Louise Clark, Nicole Guay, Clare Belmont, Claire Madsen, Claire Ward, Joe Green, Kerry Joyce, and Lynsay Duke.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Funding

Stephen Ashford is funded by the National Institute of Health Research (NIHR) in the form of a Clinical Lectureship award, 10.13039/501100000272 [CAT-CL-03-2012-010]. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the NIHR CLAHRC Northwest London or the Department for Health, UK. Funding for the preparation of the manuscript was provided by the Dunhill Medical Trust. This paper presents independent research funded by the National Institute for Health Research (NIHR) UK and NIHR CLAHRC Northwest London.