Development of Walking indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

Abstract

Objective: To describe the development of structure, process and outcome indicators that will advance the quality of walking rehabilitation for Canadians with spinal cord injury or disease (SCI/D) by 2020. Method: A framework for the evaluation of the quality of walking rehabilitation was developed by experts in walking after SCI/D. A systematic literature review identified factors influencing walking outcomes and potential walking indicators. A Driver diagram analysis summarized the factors affecting walking outcomes and subsequently informed the selection of structure and process indicators. Psychometric properties and clinical utility of potential walking indicators were considered during the selection of outcome indicators. Results: The structure indicator is the number of physical therapists using evidence-based walking interventions per number of ambulatory individuals with SCI/D. The process indicator is the number of received hours of walking interventions during inpatient rehabilitation per number of ambulatory individuals with SCI/D. The intermediary outcome indicator, which is collected at discharge from inpatient rehabilitation, is either the modified Timed Up and Go or the 10-Meter Walk Test, the choice of measure is dictated by the stage of walking recovery, as defined by the Standing and Walking Assessment Tool. The final outcome indicator, collected at 18 months post-discharge, is the Spinal Cord Independence Measure III-Mobility subscale. Conclusion: The selected indicators align with current clinical practice in Canada. The indicators will direct the timing and enhance the volume of walking therapy delivered, to ultimately increase the proportion of patients who achieve their walking potential by 18 months post-rehabilitation.

Improving practice through collaboration: Early experiences from the multi-site Spinal Cord Injury Implementation and Evaluation Quality Care Consortium

“… 20 Proportion of ambulatory individuals with SCI/D that completed the mTUG or 10MWT. 21 Proportion of regulated healthcare professionals in the program who have specialized training in wheelchair mobility and wheelchair skills development. 22 Site Kingston Hamilton London Toronto Ottawa Ottawa Change Idea Improve identification of individuals that may be appropriate for referral for EWB services or intervention.…”

Development of Reaching, Grasping & Manipulation indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

“…At this juncture, we have limited data regarding outpatient therapy provision, and functional gains or deterioration following rehabilitation discharge. 68 We also have to take into consideration that there may be an overlap between the indicator data collected for other Domains of rehabilitation care such as Walking 69 and Wheeled Mobility, 70 within the SCI-High Project. The risk with the proposed indicators is that there is a potential for double counting of interventions that can be substantially reduced with a detailed implementation plan and significant staff training for appropriate workload reporting.…”

Evaluation of the effectiveness and safety of exoskeleton in rehabilitation programs for patients with spinal cord injury

“…Специализированный опросник SCIM III «Измеритель независимости при повреждениях спинного мозга» в настоящее время используется в международной практике в качестве одного из базовых инструментов для оценки исходов реабилитации при травме спинного мозга. Критерием адекватности и эффективности проводимых реабилитационных мероприятий является увеличение общего балла в ходе реабилитации [14,15]. В нашем исследовании общий средний результат возрос к завершающему визиту 5 на 3,20 ± 0,50 балла, тогда как, по мнению некоторых авторов, увеличение на 1 балл уже является показателем эффективности проведенного лечения [16].…”