New Approach to Study the Contents and Outcomes of Spinal Cord Injury Rehabilitation: The SCIRehab Project

Background/Objective: Lack of a classification system for occupational therapy (OT) rehabilitation interventions for traumatic spinal cord injury (SCI) rehabilitation in the United States makes conducting outcomes research difficult. This article describes an OT SCI rehabilitation taxonomy (system to categorize and classify treatments). Methods: OT clinicians and researchers from 6 SCI rehabilitation centers developed a taxonomy to describe details of each OT session. This effort is part of the SCIRehab study, which uses the practice-based evidence, observational research methodology to examine current treatment processes without changing existing practice. Results: The OT taxonomy consists of 26 OT activities (eg, training on activities of daily living, communication, home management skills, wheelchair mobility, bed mobility, transfers, balance, strengthening, stretching, equipment evaluation, and community reintegration). Time spent on each activity is documented along with therapeutic interventions used to facilitate the activity. Treatment descriptions are enhanced further with identification of assistance needs, patient direction of care, and family involvement, which help to describe and guide OT activity selection. The OT taxonomy documentation process includes all OT rehabilitation interventions for patients with SCI while maintaining efficiency in data collection. Conclusion: The electronic documentation system is being used at 6 centers for all OT sessions with 1,500 patients with acute traumatic SCI. It is the largest known attempt to document details of the comprehensive OT rehabilitation process for patients with SCI in the United States.

Section: Scirehab Projectmentioning

confidence: 99%

SCIRehab Project Series: The Occupational Therapy Taxonomy

Ozelie

Sipple

Foy

et al. 2009

“…The SCIRehab project, which uses the practice-based evidence methodology that capitalizes on variations in treatments not related to patient characteristics, is described in the first article in this series by Whiteneck et al (25). This article also describes the SCIRehab hypotheses and research questions.…”

Section: Scirehab Projectmentioning

confidence: 99%

SCIRehab Project Series: The Speech Language Pathology Taxonomy

Gordan

Spivak-David

Adornato³

et al. 2009

Introduction: Outcomes research for speech language pathology (SLP) interventions for acute traumatic spinal cord injury (SCI) rehabilitation in the US is difficult because of the lack of a treatment classification system (taxonomy). Objective: To describe a taxonomy developed by speech language pathologists (SLPs) to examine the effects of SLP interventions on SCI rehabilitation outcomes. Methods: The SCIRehab study uses practice-based evidence, a rigorous observational methodology that examines treatment processes without specifying or requiring specific therapeutic interventions. Speech language pathology lead clinicians and researchers at 6 US SCI centers developed a detailed SLP taxonomy documentation process that is comprehensive of SLP interventions for patients with SCI. Results: The SLP taxonomy consists of 7 intervention categories that address deficits (speech production for patients with artificial airway, motor speech and voice, swallowing, cognitive-communication, and communication) and the associated exercises and tasks that patients perform. Time is recorded for each category, and supplementary information focuses on cueing needs and family involvement that helps to describe and guide intervention selection. The SCIRehab project is enrolling 1,500 patients with acute traumatic SCI at 6 inpatient rehabilitation facilities. Conclusions: Speech language pathology taxonomy information is being captured for the SCIRehab patients who are referred for SLP services; this may be the first attempt to document the many details of the SLP rehabilitation process for patients with SCI in the US.

“…The study design and implementation of practice-based evidence (PBE) procedures in this project have been described previously. 5,6 A SW/CM taxonomy, which classifies the types of interventions provided during acute rehabilitation, was created for the SCIRehab Project; 7 clinicians collected data on the details of the main activities that are the focus of social workers/case managers in the acute rehabilitation setting and the amount of time the social worker/case manager spends on the patient's behalf in each topic area. The introductory paper to this series of SCIRehab Project articles 8 describes the study design, including use of PBE research methodology 5,6,[9][10][11][12] inclusion criteria, data sources, and the analysis plan.…”

Section: Methodsmentioning

confidence: 99%

“…5,6 A SW/CM taxonomy, which classifies the types of interventions provided during acute rehabilitation, was created for the SCIRehab Project; 7 clinicians collected data on the details of the main activities that are the focus of social workers/case managers in the acute rehabilitation setting and the amount of time the social worker/case manager spends on the patient's behalf in each topic area. The introductory paper to this series of SCIRehab Project articles 8 describes the study design, including use of PBE research methodology 5,6,[9][10][11][12] inclusion criteria, data sources, and the analysis plan. Briefly, the SCIRehab team included representatives of all rehabilitation clinical disciplines (including SW/ CM) from six inpatient rehabilitation facilities: Craig Hospital, Englewood, CO; Shepherd Center, Atlanta, GA; Rehabilitation Institute of Chicago, Chicago, IL; Carolinas Rehabilitation, Charlotte, NC; Mount Sinai Medical Center, New York, NY; and National Rehabilitation Hospital, Washington, DC.…”

Section: Methodsmentioning

confidence: 99%

Social work and case management treatment time during inpatient spinal cord injury rehabilitation

Gassaway¹,

Abeyta

Freeman

et al. 2011

Background: There is a lack of published evidence regarding the amount and type of social work and case management (SW/CM) services that an individual with traumatic spinal cord injury (SCI) receives during acute inpatient rehabilitation. Such information is needed to assist in resource planning, benchmarking, and research on interventions and outcomes. Methods: As part of the SCIRehab study social workers and case managers at six inpatient rehabilitation facilities documented details (including time spent) about the interventions provided to 600 patients with traumatic SCI during acute inpatient rehabilitation. Associations between patient and injury characteristics and time spent on these activities were examined. Results: Patients received a mean total of 10 hours of SW/CM services, with a mean of 72.8 total minutes per week. The majority of the patients received SW/CM time spent on interdisciplinary conferencing on the patient's behalf (96%), discharge planning and services (89%), financial planning (67%), community/inhouse services (66%), supportive counseling (56%), and initial assessment (54%). A minority of the patients received peer advocacy (12%), classes (24%), and education topics (30%). Total hours per stay and minutes per week varied by level of injury group. The most time per week was dedicated to patients with high tetraplegia ASIA Impairment Scale (AIS) A-C and the least to patients with C5-C8 AIS A-C. The patient and injury characteristics studied did not explain the variance seen in time spent on specific SW/CM services. Conclusions: These descriptive data may be helpful in resource planning to anticipate and address individual patient needs and to plan for department-level training and hiring. These data also may pave the way to studying relationships of interventions with patient outcomes.