Botulinum toxin in the management of spasticity in adults

Turner-Stokes, Lynne; Ward, Anthony B.

doi:10.7861/clinmedicine.2-2-128

Cited by 38 publications

(21 citation statements)

References 12 publications

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“…15 The summary guidelines have since been approved by the Royal College of Physicians as a National Collaborating Centre for NICE, and became the first of a series of short guidelines, to be published through that mechanism. 16 Further guidelines are now in gestation, and the BSRM has drawn up procedures for guideline development which are closely modelled on the AGREE criteria. …”

Section: Guidelines For Clinical Practicementioning

confidence: 99%

The development of clinical governance in the UK: its implications for rehabilitation medicine

Turner-Stokes

2003

Clinical Medicine

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-Clinical governance has been introduced in the UK as a mechanism to improve the quality of health services, and the professional performance of clinicians. Specialist societies have a pivotal role to play in developing systems to support its implementation in clinical practice. Rehabilitation medicine is a specialty characterised by closely integrated interdisciplinary teamwork. The particular issues that this poses for clinical governance may also be relevant to other specialities. This paper presents an overview of the development of audit and clinical governance procedures in the UK and their specific implications for rehabilitation medicine. It also summarises the work undertaken to date by the British Society for Rehabilitation Medicine towards implementation of clinical governance, to improve the quality of care offered to patients. KEY WORDS: clinical audit, clinical governance, clinical standards, rehabilitation medicine Clinical governance in the UKThroughout the 1990s, clinical audit was the hallmark of quality assurance in the UK. Essential features of clinical audit were the systematic assessment of clinical practice, against agreed standards, to ensure the best quality of care. Implementation of change was then followed by re-audit to complete the audit cycle.However, audit had no real teeth. There was no statutory duty applicable to NHS hospital trusts with respect to quality of care. In a competitive openmarket health system, the only statutory requirement for hospital managers was to maintain financial balance. In 1998, the UK Government introduced reforms for 'modernisation' . 1 Clinical governance was the framework through which NHS organisations would be 'accountable for continuously improving the quality of their services' . The audit cycle became the audit spiral (Fig 1), 2 and hospital trust boards now had statutory responsibility for the quality of services, as well as financial management. 3 Nationally agreed standards and guidelinesA central tenet of clinical governance is the elimination of unnecessary variation in practice. 'Benchmarking' is now required against nationally agreed standards which are based on research evidence or consensus of widely gathered expert opinion.The terms 'standards' and 'guidelines' are sometimes used interchangeably, but this is incorrect.Standards define the quality of service delivery, while guidelines provide guidance to the clinician for individual patient care. A 'standard' is therefore interpreted at the level of a population, while a 'guideline' is interpreted at the level of the individual. Nevertheless there is a close relationship between the two, illustrated in Box 1. 4 If guidelines are to become 'compulsory' practice, the advice must be correct and up to date. Guideline developers carry a major responsibility and the process must be meticulous. In the UK, the Scottish Intercollegiate Guidelines Network (SIGN) pioneered guideline development with a rigorous system of gathering and evaluating evidence, achieving consensus through consu...

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Section: Guidelines For Clinical Practicementioning

confidence: 99%

The development of clinical governance in the UK: its implications for rehabilitation medicine

Turner-Stokes

2003

Clinical Medicine

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“…By limiting the capacity to exercise, spasticity can lead to cardiovascular deconditioning and exacerbate muscular weakness. Therapeutic goals for spasticity management should be identified with the multidisciplinary team, and treatment should be systematic, with good documentation 11 . Individuals with MS need to understand the importance of time for exercising and stretching so that the new movement patterns can be made a part of everyday living.…”

Section: Painmentioning

confidence: 99%

Supporting Individuals with Disabling Multiple Sclerosis

Gibson

Frank

2002

J R Soc Med

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“…This measure has shown a clinically important change in geriatric care, mental health, and chronic pain settings. 6 The strength and main feature of this tool are that it quantifies goal achievement through a singleinterval measure ranging from not achieving to exceeding the goal. Because individuals with upper motor neuron syndrome are heterogeneous, individualized treatment goals based on their needs are meaningful to them and their family.…”

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confidence: 99%

“…This speeds up the intervention and also prevents free-flowing goals. 6 As a rule, clinicians must assist patients and their families on the basis of a patient's motor recovery stage. Educating them about the correlation between improvement in function and baseline limb impairment could be helpful in selecting realistic goals.…”

mentioning

confidence: 99%

“…To measure the effectiveness of BoNTA in an adult with spasticity, setting goals for intervention and evaluation of the intervention is recommended as a best practice guideline. 6 Goal Attainment Scaling (GAS) is a measure that aims to assess the effectiveness of BoNTA. This measure has shown a clinically important change in geriatric care, mental health, and chronic pain settings.…”

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confidence: 99%

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