Content » Vol 49, Issue 5

Original report

Influence of physician empathy on the outcome of botulinum toxin treatment for upper limb spasticity in patients with chronic stroke: A cohort study

Alessandro Picelli, Gabriella Vallies, Elena Chemello, Alessandro Gavras, Paola Castellazzi, Andrea Meschieri, Anna Serina, Marialuisa Gandolfi, Alessio Baricich, Andrea Santamato, Carlo Cisari, Nicola Smania
Department of Neurosciences, Biomedicine and Movement Sciences,, University of Verona, IT-37134 Verona, Italy. E-mail:
DOI: 10.2340/16501977-2231


Objective: To examine the relationship between patient-rated physician empathy and outcome of botulinum toxin treatment for post-stroke upper limb spasticity.
Design: Cohort study.
Subjects: Twenty chronic stroke patients with upper limb spasticity.
Methods: All patients received incobotulinumtoxinA injection in at least one muscle for each of the following patterns: flexed elbow, flexed wrist and clenched fist. Each treatment was performed by 1 of 5 physiatrists with equivalent clinical experience. Patient-rated physician empathy was quantified with the Consultation and Relational Empathy Measure immediately after botulinum toxin treatment. Patients were evaluated before and at 4 weeks after botulinum toxin treatment by means of the following outcome measures: Modified Ashworth Scale; Wolf Motor Function Test; Disability Assessment Scale; Goal Attainment Scaling.
Results: Ordinal regression analysis showed a significant influence of patient-rated physician empathy (independent variable) on the outcome (dependent variables) of botulinum toxin treatment at 4 weeks after injection, as measured by Goal Attainment Scaling (p < 0. 001).
Conclusion: These findings support the hypothesis that patient-rated physician empathy may influence the outcome of botulinum toxin treatment in chronic stroke patients with upper limb spasticity as measured by Goal Attainment Scaling.

Lay Abstract

Botulinum toxin is an effective and safe treatment for spasticity. However some goals of treatment are often difficult to achieve. We studied the role of physician empathy in the treatment of upper limb spasticity with botulinum toxin in 20 chronic stroke patients. It could be concluded that a more empathic relationship between patients and physicians may have a positive influence on the goal attainment of botulinum toxin treatment in upper limb spasticity due to chronic stroke.


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