The meaning of Botulinum Toxin for Adults living with Long Term Neurological Conditions: A hermeneutic study

Purpose: Botulinum toxin is a neurotoxin used in the management of spasticity, which can occur with neurological disease and injury. Botulinum toxin therapy is well evidenced in its ability to change the clinical rating of spasticity. However, research which has utilised quantitative methods has been less conclusive concerning its impact on an individual's function or quality of life and whether the intervention offers sufficient cost-benefits. This study aimed to provide a unique perspective on the meaning of botulinum toxin therapy for individuals living with a long term neurological condition
Methods: This qualitative research study used semi structured interviews to collect detailed accounts from five individuals receiving botulinum toxin injections, on the experience and meaning of this intervention from their perspective. Analysis of these accounts drew on the principles of philosophical hermeneutics.
Results: The understanding that emerged of botulinum toxin therapy was that it was experienced as offering merits beyond function by making lives better and easier for people a with long term neurological condition. The findings illustrate descriptions of bodily felt changes which went beyond the expected physical responses that are recognised with this treatment. Botulinum toxin therapy was found to assist in reducing discomfort, rewinding lost ability, improving their psychological and social well-being, regaining control and ownership over their lives, and ultimately restoring a positive sense of self. Conclusion(s): This study has generated unique insights into the meaning of botulinum toxin therapy for individuals living with long term neurological conditions, which contribute to the existing quantitative evidence base concerning its effectiveness. Experiences of this therapy highlighted interconnected internal, emotional, personal and self-related responses to botulinum toxin therapy which have not been previously appreciated. Further consideration in clinical practice is needed of the non-observable, personal and wider value of botulinum toxin therapy, and offers a foundation for further research in this area. Implications: The findings of this study offer a perspective on the interconnected meaning of having botulinum toxin therapy for spasticity, where it emphasises its potential role as a foundation, catalyst and enabler across a number of spheres for people living with a neurological condition. These findings have relevance within the current climate where supporting individuals with the self-management of their condition is a key focus. This study also offers implications for clinicians in how they acknowledge, communicate and explore the varied nature of such responses to botulinum toxin therapy. These small physical or sensory changes facilitated by botulinum toxin therapy may have meaningful implications for the restoration of psychological and emotional wellbeing and may contribute to further research into the development of more sensitive, individualised and meaningful ways of evaluating botulinum toxin therapy, and exploring the development of condition specific QOL measures.