Evaluating the effectiveness of a multidisciplinary hypertonicity service to inform the development of a state-wide service model for management of hypertonicity post brain injury

About the Project

Up to 42% of people experience hypertonicity (muscle over-activity) after brain injury. Consequences include joint contractures, pressure areas, pain, muscle weakness and tightness leading to disability, reduced quality of life and increased health care costs. Evidence suggests Botulinum toxin injections and therapy can successfully counteract these problems. Ideally patients should receive management in their local area to maximise access, support and continuity of care. We plan to make this happen by applying new knowledge of patient outcomes to the development of a best practice state-wide model of multidisciplinary hypertonicity management. Project findings will inform the proposed development of a service framework, procedures and protocols to enable the establishment of four hypertonicity hub services across the state to provide consistent, effective assessment and hypertonicity management for patients following brain injury.

The Princess Alexandra Hospital Hypertonicity Service (PAHTS) currently provides the only specialist service in Queensland and the multidisciplinary team is the recognised state leader in the field. This has been recently verified following the recent review of the UK Guidelines: Spasticity in adults: management using botulinum toxin to which PAHTS complies as well as partnership interest from international services and pharmaceutical companies.

The primary aim of this project is to evaluate and refine the PAHTS delivery model for future state-wide implementation by investigating the pattern of outcomes of hypertonicity patients using secondary data analysis, and identifying the association between goal achievement, patient and service characteristics and successful hypertonicity management. The anticipated key benefits of the research include consistent, easily accessible and high-quality hypertonicity management, promoting improved function and daily life participation for all Queensland patients. Examining the effectiveness of this service is critical to development of a best practice service model to enhance service capacity across the state and ensure all Queenslanders have optimal health care. 

The PAHTS will link with the Queensland State-wide Adult Brain Injury Rehabilitation Plan project team to identify opportunities to increase access to Hypertonicity Services through Hub Sites. Project findings will inform the development of a service framework, procedures and protocols to enable the establishment of four hypertonicity hub services across the state to provide consistent, effective assessment and hypertonicity management for patients following brain injury.

This project involves the collaboration between expert Clinicians from Medical and Allied Health fields and Hopkins Centre Researchers.

Project Status

Even though only at initial stages of the project, through the process of service data cleaning and coding, specific notes for standardising data collection practices across the state have been made. This study builds upon 8 years of service data involving 329 patients and 1200 clinical assessments. This has led to a significant impact on the future of state wide data collation through the integrated Electronic Medical Record (iEMR) at PAH (and the planned roll out to 24 Queensland hospitals by 2020). PAHTS has commenced development of iEMR Hypertonicity assessment and management Power Forms with the purpose of communicating patients’ hypertonicity management and collecting standardised assessment data for quality benchmarking and future practice-based research across Queensland. The project will inform and refine the development of this data collection tool with the aim of providing a registry of people undergoing hypertonicity management in Queensland. The feasibility of developing a dashboard reporting system for Queensland Hypertonicity Services will be investigated.

Ethics and governance approval for the project is in place, with priliminary data collection has complete and focus groups currently in progress. It is anticipated knowledge will be generated upon completion of the data analysis and following service user focus groups.

The team has also presented recently on the project aims, objectives and project plan to industry representatives, generating positive feedback and interest in the project outcomes building on long standing professional collaborations.

Another notable contribution to this study has been the recent involvement of Professor Lynne Turner-Stokes, Kings College London, who met with the research team recently and has commended their approach and work to date. She will remain a committed advisor to the project and discussions about comparative studies are underway. As the UK Clinical Research Lead for the ULIS program, ULIS has generated several large international cohort studies of real life clinical practice in the use of botulinum toxin and concomitant therapies for the management of upper limb spasticity.

The next stage of research in the pilot project involves focus groups with patients and collection of their experiences and outcomes from the service. It is anticipated that some of these stories will be shared publicly to raise awareness of the life-changing outcomes from this treatment for Queenslanders with brain injury.

This project is in progress, so stay tuned for more to come....

This project involves the collaboration between expert Clinicians from Medical and Allied Health fields and Hopkins Centre Researchers.

The primary aim of this project is to evaluate and refine the PAHTS delivery model for future state-wide implementation by investigating the pattern of outcomes of hypertonicity patients using secondary data analysis, and identifying the association between goal achievement, patient and service characteristics and successful hypertonicity management.

The anticipated key benefits of the research include consistent, easily accessible and high-quality hypertonicity management, promoting improved function and daily life participation for all Queensland patients.

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This project has just commenced, so stay tuned for more to come....