Botulinum toxin for people with dystonia treated by an outreach nurse practitioner: A comparative study between a home and a clinic treatment service

Objective: To study whether a trained outreach nurse practitioner could pro vide a service that is as good as, or better than, that provided at a hospi tal outpatient clinic for people who had been diagnosed with dystonia and r equired treatment with botulinum toxin. Design: Randomized trial. Setting: An outpatient department of a regional neurorehabilitation center and patients homes in northern England. Patients: Eighty-nine patients with a clinical diagnosis of spasmodic torti collis. blepharospasm. or hemifacial spasm who had ongoing treatment of dys tonia with botulinum injections. Interventions: Individuals were randomly allocated either to receive ongoin g botulinum injections at home by the nurse practitioner or to continue att ending the hospital outpatient clinic and be injected by medical staff. Main Outcome Measures: The following measures were recorded at each visit: demographic descriptors, dosage of botulinum toxin, treatment interval, sid e-effect profile. external referrals, and a questionnaire to determine qual itative opinion, Results: Efficacy and duration of the botulinum was similar in both groups. Botulinum dosage and side-effect profiles were similar in both groups exce pt for significantly less dysphagia (p < .018) in the home group (7 vs 24 o ccasions). Subjective opinion by the patients indicated statistically signi ficant preference for home injections. Economic analysis indicated that the overall cost of the treatment was less in the home injection group (total cost per visit $36.90 [<pound>23.36] vs $79.00 [pound 50.01]). hut this dif ference was not statistically significant. Conclusion: A trained outreach nurse practitioner provided a service that w as as good as, and in certain aspects better than, that provided by a hospi tal outpatient clinic. The nurse practitioner provided a more flexible, muc h appreciated, safe, and cost-effective service for this client group. Wide r use of outreach nurse practitioners for dystonia should be encouraged.