Selection process for botulinum toxin injections in patients with chronic-stage hemiplegic stroke: a qualitative study

Background: Botulinum toxin (BT) injection is a new treatment for spasticity with hemiplegia after stroke. How a patient decides to receive BT injections after becoming aware of the treatment remains unclear. In this exploratory qualitative study, we aimed to investigate patients' decision-making about treatment strategies in collaboration with family and health professionals and to identify conflicts in patients' feelings about BT treatment. Methods: The study included six patients with stroke sequelae. Data were collected using comprehensive interviews and were analyzed using the grounded theory approach and trajectory equifinality modeling. Results: After patients learned about BT treatment, they clearly exhibited the following two concurrent perceptions: "the restriction of one's life due to disabilities" and "the ability to do certain things despite one's disabilities." Some patients reported a "fear of not being able to maintain the status quo owing to the side effects of BT." To alleviate this fear, timely support from family members was offered, and patients overcame anxiety through creative thinking. However, there were also expressions that revealed patients' difficulties dealing with negative events. These factors influenced the patients' development of "expectations of BT" or "hesitations about BT." Conclusions: To establish treatment strategies in collaboration with patients, healthcare professionals should show supportive attitudes and have discussions with patients and their family members to help patients resolve their conflicts and should establish treatment strategies that maintain the positive aspects of patients' lives.