# Aligning Minds in Spasticity Care—A Two-Phase Delphi-Dialogue Study of Patients and Professionals in Spain

## TL;DR

This study explores how patients and professionals in Spain can better align on spasticity care, focusing on botulinum toxin treatment and rehabilitation.

## Contribution

The study introduces a two-phase Delphi-Dialogue method to generate consensus-based recommendations for improving spasticity management.

## Key findings

- Patients and professionals agree on the benefits of botulinum toxin and the need for ongoing rehabilitation.
- Key gaps include access to rehabilitation services and shared goal setting.
- Experts prioritized recommendations for standardizing access and optimizing botulinum toxin use.

## Abstract

Background: Spasticity, which occurs with certain neurological conditions, substantially affects quality of life, function, and social participation. Despite widespread botulinum toxin use, variability persists in patient information, access to specialized rehabilitation, and follow-up models. Methods: This two-phase Delphi-Dialogue Patients–Professionals study (DDPP), promoted by SERMEF, integrated perspectives from 77 patients and 141 rehabilitation professionals. Phase 1 used parallel surveys to assess satisfaction, perceived effectiveness of botulinum toxin, communication preferences, and rehabilitation follow-up. Phase 2 applied Real-Time Delphi with 38 experts to generate consensus recommendations to improve spasticity management. Results: Patients and professionals agreed on botulinum toxin benefits, the importance of ongoing rehabilitation, and the value of hybrid (in-person/remote) follow-up. Key gaps concerned access to Physical Medicine and Rehabilitation services, clarity and timing of information, and shared goal setting. Experts translated these misalignments into 10 prioritized recommendations, with highest feasibility for actions standardizing access pathways, optimizing botulinum toxin use, reinforcing structured education, and consolidating hybrid rehabilitation models. Conclusions: The DDPP approach offers a reproducible framework to align stakeholder perspectives by converting quantified divergence into consensus-based innovation priorities. Implementing the recommendations—particularly those strengthening communication, education, and hybrid pathways regarding botulinum toxin treatment—may support more accessible, personalized, patient-centered spasticity care.