Ergonomic Recommendations in Ultrasound-Guided Botulinum Neurotoxin Chemodenervation for Spasticity: An International Expert Group Opinion

Area of Science:

• Neurology
• Musculoskeletal Medicine
• Medical Training

Background:

• Ultrasound (US)-guided botulinum neurotoxin (BoNT) injections are standard for managing muscle spasticity in upper motor neuron syndromes.
• Training courses for US-guided BoNT injections are increasing, but often neglect ergonomic principles.

Purpose of the Study:

• To emphasize the significance of ultrasound ergonomics in BoNT injections for spasticity.
• To provide expert-backed ergonomic recommendations for optimizing US-guided BoNT injection techniques.

Main Methods:

• Expert consensus from 11 physicians across 8 countries with extensive experience in US-guided BoNT.
• A comprehensive literature search revealed no prior publications on ergonomics in US-guided chemodenervation.
• A 20-question survey distributed to ultrasound experts informed consensus discussions and recommendations.

Main Results:

• All surveyed experts agreed ergonomics is vital for reducing physician injury.
• Strong consensus (≥80%) was reached on the importance of physician positioning, patient positioning, and ultrasound machine positioning.
• Four key ergonomic categories were identified: workstation, physician, patient, and visual ergonomics.

Conclusions:

• Optimizing ergonomics, including workspace setup and adequate pre-injection positioning time, is paramount for effective US-guided BoNT chemodenervation in spasticity.
• Neglecting ergonomics can lead to suboptimal patient results, increased physician work-related injuries, and patient discomfort.
• The study proposes essential elements for optimal positioning and workspace setup, alongside clinical insights for identifying spastic muscles.