Emerging Concepts and Evidence in Telematics Novel Approaches or Treatments for Spasticity Management After Botulinum Injection

There is a strong recommendation for the use of intramuscular botulinum toxin in patients with persistent or progressive spasticity affecting one or more joints and who have an identifiable therapeutic target. After a botulinum toxin injection, a stretching intervention improves the results of the treatment, and it should be performed by patients and/or caregivers after being trained by a therapist. Adherence to this recommendation remains low once the therapist stops following the patient. The COVID-19 pandemic has increased the use of telemedicine with different approaches to treat patients. There has been an increased use of motivational applications, with virtual reality software and real-life videos, which provide a gaming experience that increases adherence. There are programs with synchronous telehealth exercises guided by physical therapists or software with sensor-based technology that shows the range of motion (ROM) and strength of the muscles of a particular joint. These new approaches to patient follow-up appear to increase adherence to exercise because they need to be “watched and controlled” is achieved.

Factorial Structure of the Therapist Adherence Measure-Revised (TAM-R) Within Multisystemic Therapy

The Therapist Adherence Measure (TAM-R) is a central assessment within the quality-assurance system of Multisystemic Therapy (MST). Studies into the validity and reliability of the TAM in the US have found varying numbers of latent factors. The current study aimed to reexamine its factor structure using two independent samples of families participating in MST in the Netherlands. The factor structure was explored using an Exploratory Factor Analysis (EFA) in Sample 1 ( N = 580). This resulted in a two-factor solution. The factors were labeled “therapist adherence” and “client–therapist alliance.” Four cross-loading items were dropped. Reliability of the resulting factors was good. This two-factor model showed good model fit in a subsequent Confirmatory Factor Analysis (CFA) in Sample 2 ( N = 723). The current finding of an alliance component corroborates previous studies and fits with the focus of the MST treatment model on creating engagement.

Measuring Adherence to Key Teaching Techniques in an Evidence-Based Treatment: A Comparison of Caregiver, Therapist, and Behavior Observation Ratings

Traditionally, treatment adherence has been measured in outcome studies by highly trained, independent raters who code audio- or video-taped treatment sessions to understand therapists’ adherence to preestablished treatment session components. Unfortunately, this method of assessing treatment adherence is time-, labor-, and cost-intensive, and does not translate well to community settings. This study compared expert-coded behavior observations, therapist and caregiver report of therapists’ adherence to nine teaching technique items assessed in treatment sessions using Alternatives for Families: A Cognitive Behavioral Therapy (AF-CBT) to determine whether other raters (outside of traditional expert coders) could effectively and accurately measure therapist adherence. A total of 533 therapy sessions were coded across experts ( n = 2), therapists ( n = 20), and caregivers ( n = 42). Outcomes indicated strikingly different ratings across all reporters suggesting that therapist and caregiver reports may be supplement to, but not substitute for, observer ratings.