Background: Spasticity significantly impacts quality of life, function, and social participation in individuals with neurological conditions. Despite the widespread use of botulinum toxin, 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 the Spanish Society of Physical Medicine and Rehabilitation (SERMEF), integrated perspectives from 77 patients and 141 rehabilitation professionals. In Phase 1, parallel surveys assessed satisfaction, perceived effectiveness of botulinum toxin, communication preferences, and rehabilitation follow-up. In Phase 2, a Real-Time Delphi process with 38 experts generated consensus recommendations for improving spasticity management. Results: Patients and professionals broadly agreed on the benefits of botulinum toxin, the importance of ongoing rehabilitation, and the value of hybrid (in-person/remote) follow-up, but relevant gaps emerged regarding access to Physical Medicine and Rehabilitation services, clarity and timing of information, and shared goal setting. The expert panel converted these misalignments into a prioritized set of ten recommendations, with the highest feasibility assigned to actions that standardize access pathways, optimize botulinum toxin use, reinforce structured education, and consolidate hybrid rehabilitation models. Conclusions: The DDPP methodology provides a reproducible framework for aligning patient and professional perspectives in spasticity care by transforming quantified divergence into consensus-based innovation priorities. Implementing the agreed recommendations—especially those that reinforce communication, structured education, and hybrid rehabilitation pathways around botulinum toxin treatment—may help spasticity services evolve toward a more accessible, personalized, and patient-centered model.