Category: Dystonia: Clinical Trials and Therapy
Objective: To evaluate the potential benefits of a post injection telehealth follow-up visit for people with cervical dystonia.
Background: Cervical dystonia (CD) is characterized by involuntary contraction of the cervical musculature leading to a sustained or intermittent twisting or movement of the head, neck, or shoulders1–3. Left untreated, the head is abnormally positioned, causing moderate to severe pain in 71% of patients1. Botulinum toxin injection is the first-line therapeutic for management of CD and peak effectiveness occurs within the first month. Recurring injection visits typically occur approximately three months apart. Telemedicine is convenient and cost-effective for patients and providers4,5. This study explores the potential benefits of follow-up telehealth visits between injection cycles.
Method: Participants with cervical dystonia treated with botulinum toxin at Vanderbilt University Medical Center provided informed consent (IRB 190232) and were assessed via telehealth 2-4 weeks post-injection over a maximum of two treatment cycles. To determine the value of the telehealth follow-up visit, the treating clinician assessed on a scale of 0 to 4 (4 = very helpful, 0 = not at all helpful) how informative the telehealth visit was for muscle selection, toxin dose, toxin type, and the interval between treatments. At the two subsequent injection visits, the clinician assessed if the telehealth follow-up visit; 1) informed decisions regarding the treatment, 2) influenced a change in the treatment paradigm.
Results: Participants (n=27) completed 29 telehealth follow-up visits between May 15, 2019, and March 26, 2020. Clinicians rated the value of the telehealth visit as helpful or very helpful for muscle selection 86%, toxin dose 76%, toxin type 17%, and interval between treatments 34%. At the subsequent injection visit, clinicians indicated that the telehealth follow-up visit informed decisions regarding treatment 96% and influenced a change in the treatment paradigm 48%.
Conclusion: For people with cervical dystonia, post injection telehealth follow-up visits during peak effect are likely beneficial for informing treatment decisions such as muscle selection and toxin dose. Further investigation is needed to better understand the potential benefits of telehealth in the management of cervical dystonia.
References: 1. Charles PD, Manack Adams A, Davis T, Bradley K, Schwartz M, Brin MF PA. Neck Pain and Cervical Dystonia: Treatment Outcomes from CD PROBE. Pain Pr. 2016. https://onlinelibrary.wiley.com/doi/abs/10.1111/papr.12408.
2. Kutvonen O, Dastidar P, Nurmikko T. Pain in spasmodic torticollis. Pain. 1997;69(3):279-286. doi:10.1016/S0304-3959(96)03296-4.
3. Jankovic J, Tsui J, Bergeron C. Prevalence of cervical dystonia and spasmodic torticollis in the United States general population. Park Relat Disord. 2007;13(7):411-416. doi:10.1016/j.parkreldis.2007.02.005.
4. FS Mair, A Haycox, C May, T Williams. A review of telemedicine cost-effectiveness studies. J Telemed Telecare. 2000. http://journals.sagepub.com/doi/abs/10.1258/1357633001934096.
5. Susan S. Gustke David C. Balch Vivian L. West Lance O. Rogers. Patient Satisfaction with Telemedicine. Telemed J. 2004. https://doi.org/10.1089/107830200311806.
To cite this abstract in AMA style:K. Harper, S. Sharp, N. Jones, M. Turchan, M. Hacker, J. Meystedt, S. Ploucher, L. Schattinger, D. Makini, A. Terala, D. Charles. Telehealth Follow-up for Cervical Dystonia Treated with Neurotoxin Injection [abstract]. Mov Disord. 2023; 38 (suppl 1). https://www.mdsabstracts.org/abstract/telehealth-follow-up-for-cervical-dystonia-treated-with-neurotoxin-injection/. Accessed September 28, 2023.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/telehealth-follow-up-for-cervical-dystonia-treated-with-neurotoxin-injection/