Ambulatory Botulinum Neurotoxin Injections for Dystonia, Spasticity, and Hemifacial Spasms: Predictors of Adherence a Year Before, During, and Late Covid-19 Pandemic

ABSTRACT

Objective: The relevance of the study is to primarily determine the predictors of adherence (distance, socio-economic status, disease status, and treatment schedule) of patients with dystonia, spasticity, and hemifacial spasms in a single center Botulinum neurotoxin injection (BoNT) study. Background(s) In December 2019, there was a new type of coronavirus identified in Wuhan, China which rapidly escalated to all parts of the world, the Philippines included. The COVID 19 pandemic did not only affect the patients contracted with the disease, but also those who have non-communicable diseases including dystonia, spasticity, and hemifacial spasm. BoNT is a chemodenervating agent that reduces muscle hyperactivity and spasms. Continuation of outpatient treatment may be affected due to the following reasons lack of access to the health care system because of travel restrictions or lockdowns;fear of contracting the virus;and finances, which has a bigger impact on lower income patients. Method(s) This study utilized a cross-sectional research design with a total of 120 samples. Inclusion and exclusion criteria were met. Consent was secured. Data was gathered through chart reviews, telecommunications, and evaluation after receiving BoNT treatment in three different timelines-a year before (March 1, 2019 to February 29, 2020), during (March 1, 2020 to February 28, 2021), and late COVID 19 pandemic (March 1, 2021 to February 28, 2022). Result(s) The result of this study using percentages and p-values demonstrated a higher percentage in the distance and socio-economic status, as well as in the lost to follow up rate when compared to the other group. Distance and patients lost to follow up had p-values of less than 0.05. Therefore, only distance was noted to be a significant factor to the adherence status of patients. Furthermore, the lost to follow up rate in the COVID 19 pandemic period is also significantly higher when compared to that of the other group. Conclusion(s) It is concluded that patients with closer distance to the facility had better adherence hence the researchers recommend having an affiliate clinic or a referral facility for patients residing outside Metro Manila for better adherence.