Cross-cultural differences in preference for recovery of mobility among spinal cord injury rehabilitation professionals

Abstract

Study design: Direct observation of a constrained consensus-building process in three culturally independent five-person panels of rehabilitation professionals from the US, Italy and Canada. Objectives: To illustrate cultural differences in belief among rehabilitation professionals about the relative importance of alternative functional goals during spinal cord injury (SCI) rehabilitation. Setting: Spinal Cord Injury Units in Philadelphia-USA, Rome-Italy and Vancouver-Canada. Methods: Each of the three panels came to independent consensus about recovery priorities in SCI utilizing the features resource trade-off game. The procedure involves trading imagined levels of independence (resources) across different functional items (features) assuming different stages of recovery. Results: Sphincter management was of primary importance to all three groups. The Italian and Canadian rehabilitation professionals, however, showed preference for walking over wheelchair mobility at lower stages of assumed recovery, whereas the US professionals set wheelchair independence at a higher priority than walking. Conclusions: These preliminary results suggest cross-cultural recovery priority differences among SCI rehabilitation professionals. These dissimilarities in preference may reflect disparities in values, cultural expectations and health care policies.

Who wants to walk? Preferences for recovery after SCI: a longitudinal and cross-sectional study

“…Management of bowel and bladder is seen as paramount to independence. This is universally reported in the general literature 14,17,18 and also in cross-cultural features game studies, 16 demonstrating concurrent validation utilizing a new methodology.…”

“…When queried, the rehRx panel participants responded that in the current reimbursement environment, in the USA, of having to discharge patients early in their rehabilitation, it is necessary to focus first on wheelchair independence and plan for ambulation training as an outpatient. Other cultures treat consumers as inpatients until they plateau, and the features game research reflects this differential (see detailed discussion in Ditunno et al 16 ).…”

“…The features game was originally developed and validated using the FIM, and has recently been used to measure consumer preference in SCI. 12,16 Six items of self-care, two items of sphincter control and six items of mobility comprised the MFIM, with a total of 14 items. Only the motor items of the FIM were utilized, as they correlate with the severity of neurological impairment and recovery.…”

“…The game uses the nominal group process that is integrated with concepts from economic utility analysis; this process assures that each panelist has equal opportunity for input. The game is played on a large board with the 14 MFIM items listed down the left side of the board and 7 performance levels (1: total assistance; 2: maximal assistance; 3: moderate assistance; 4: minimal assistance; 5: supervision; 6: independence with device; 7: complete independence) listed across the top (see Ditunno et al 16 ). Researcher training Data collection…”

Exploring the Personal Reality of Disability and Recovery: A Tool for Empowering the Rehabilitation Process

“…Variation in understanding recovery priorities among patients and clinicians may also exist cross-culturally (Ditunno et al, 2006) and across people living in different natural environments (Stineman et al, 1998). The existence of value differences across people may lead us to believe that patient recovery preferences are more individually unique than the medical community previously assumed.…”