Spasticity in adults: management of botulinum toxin

Abstract

the NHS Outcomes Framework 2011/12 from the department of health states that reducing health inequalities and promoting equality is central if the nhs is to deliver health outcomes that are among the best in the world. 1 assessment of patient reported outcome measures (prOms) was introduced across the nhs in april 2009 both for hip and knee replacement surgery. prOms are applied before and after certain elective health interventions funded by the nhs. 2 in addition to the established use in assessment of outcomes, it has been suggested that preoperative instruments might be used to assess whether referrals for elective procedures are appropriate and also to identify inequalities in heathcare. 2 for hip and knee replacement surgery, Oxford hip 3 and knee 4 scores are used as the measure of pain and disability. Many primary care trusts (PCTs), soon to evolve into Clinical Commissioning Groups (CCGs) and GPs are now using Oxford hip and knee scores as selection criteria for orthopaedic surgery. 5–8 Several have set a benchmark whereby patients with an Oxford score worse than 30 (on a scale of 48 to 0) delineates whether or not they will qualify for a hip or knee replacement. 5–7 As Oxford scores are not a validated triage tool for individuals, it is questionable whether PCTs are enabling the best possible decisions to be taken for their patients. The aim of this study was to examine which patients would be most affected by the introduction of a cut-off Oxford score before they could be considered suitable for lower limb arthroplasty surgery. methods All patients attending for lower limb arthroplasty at a specialist orthopaedic hospital between January 2008 and January 2011 were included in the study. As part of the institution's normal practice, patients were asked to complete Oxford scores preoperatively and at each subsequent postoperative attendance. Data from the completed questionnaires were entered and stored on the hospital's audit database. This database also contains demographic information on the patients, details of any surgery performed and any complications that may have occurred. The database was introduced in 1997. It has stored National Joint Registry data for hip and knee arthroplasty procedures performed at this institution. For this study, only scores made within six months prior to the arthroplasty surgery were included. Oxford scores with ten or