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Pinto JO, Peixoto B, Dores AR, Barbosa F. Proposal of a common terminology for the neuropsychological rehabilitation. J Neuropsychol 2023; 17:431-449. [PMID: 36891955 DOI: 10.1111/jnp.12310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/03/2023] [Accepted: 02/16/2023] [Indexed: 03/10/2023]
Abstract
The literature on neuropsychological intervention (NI) uses a variety of terms to refer to equivalent constructs, making it difficult to compare intervention programmes and their outcomes. The purpose of this work is to propose a unified terminological framework for describing NI programmes. The terminological framework was developed based on a previous proposal for common terminology by Johnstone and Stonnington (Rehabilitation of neuropsychological disorders: A practical guide for rehabilitation professionals. Psychology Press, 2011) and driven by Cognitive Psychology concepts. The terminological framework was organized into two sections: (a) NI, which includes types of NI, methods and approaches, instructional methods, and strategies; and (b) neurocognitive functions, which include temporal and spatial orientation, sensation, perception, visuo-constructional abilities, attention, memory, language, reasoning of several sorts (e.g., abstract reasoning, and numerical reasoning), and executive functions. Most NI tasks target a main neurocognitive function, but there are underlying neurocognitive functions that may impair performance in the former. Since it is difficult to create a task that is solely focused on one neurocognitive function, the proposed terminology should not be viewed as a taxonomy, but rather as dimensional, with the same task allowing to work different functions, in varying grades. Adopting this terminological framework will allow to define the targeted neurocognitive functions more accurately and simplify the comparison between NI programmes and their outcomes. Future research should focus on describing the main techniques/strategies for each neurocognitive function and non-cognitive interventions.
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Affiliation(s)
- Joana O Pinto
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- ESS, Polytechnic Institute of Porto, Porto, Portugal
- CESPU, University Institute of Health Sciences, Gandra, Portugal
| | - Bruno Peixoto
- CESPU, University Institute of Health Sciences, Gandra, Portugal
- NeuroGen - Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- TOXRUN - Toxicology Research Unit, University Institute of Health Sciences, CESPU, Gandra, Portugal
| | - Artemisa R Dores
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- ESS, Polytechnic Institute of Porto, Porto, Portugal
- Center for Rehabilitation Research, ESS, Polytechnic of Porto, Porto, Portugal
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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Psychological morbidity following spinal cord injury and among those without spinal cord injury: the impact of chronic centralized and neuropathic pain. Spinal Cord 2022; 60:163-169. [PMID: 35058578 PMCID: PMC8828667 DOI: 10.1038/s41393-021-00731-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/28/2022]
Abstract
Study Design: Longitudinal cohort study of privately-insured beneficiaries with and without traumatic spinal cord injury (SCI). Objectives: Compare the incidence of and adjusted hazards for psychological morbidities among adults with and without traumatic SCI, and examine the effect of chronic centralized and neuropathic pain on outcomes. Setting: Privately-insured beneficiaries were included if they had an ICD-9-CM diagnostic code for traumatic SCI (n=9,081). Adults without SCI were also included (n=1,474,232). Methods: Incidence of common psychological morbidities were compared at 5-years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident psychological morbidities. Results: Adults with SCI had a higher incidence of any psychological morbidity (59.1% vs. 30.9%) as compared to adults without SCI, and differences were to a clinically meaningful extent. Survival models demonstrated that adults with SCI had a greater hazard for any psychological morbidity (HR: 1.67; 95%CI: 1.61, 1.74), and all but one psychological disorder (impulse control disorders), and ranged from HR: 1.31 (1.24, 1.39) for insomnia to HR: 2.10 (1.77, 2.49) for post-traumatic stress disorder. Centralized and neuropathic pain was associated with all psychological disorders, and ranged from HR: 1.31 (1.23, 1.39) for dementia to HR: 3.83 (3.10, 3.68) for anxiety. Conclusions: Adults with SCI have a higher incidence of and risk for common psychological morbidities, as compared to adults without SCI. Efforts are needed to facilitate the development of early interventions to reduce risk of chronic centralized and neuropathic pain and psychological morbidity onset/progression in this higher risk population.
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Monden KR, Hidden J, Eagye CB, Hammond FM, Kolakowsky-Hayner SA, Whiteneck GG. Relationship of patient characteristics and inpatient rehabilitation services to 5-year outcomes following spinal cord injury: A follow up of the SCIRehab project. J Spinal Cord Med 2021; 44:870-885. [PMID: 33705276 PMCID: PMC8725682 DOI: 10.1080/10790268.2021.1881875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To examine associations of patient characteristics and treatment quantity delivered during inpatient spinal cord injury (SCI) rehabilitation with outcomes at 5 years post-injury and compare them to the associations found at 1 year post-injury. DESIGN Observational study using Practice-Based Evidence research methodology in which clinicians documented treatment details. Regression modeling was used to predict outcomes. SETTING Five inpatient SCI rehabilitation centers in the US. PARTICIPANTS Participants were 792 SCIRehab participants who were >12 years of age, gave informed consent, and completed both a 1-year and 5-year post-injury interview. OUTCOME MEASURES Outcome data were derived from Spinal Cord Injury Model Systems (SCIMS) follow-up interviews at 5 years post-injury and, similar to the 1-year SCIMS outcomes, included measures of physical independence, societal participation, life satisfaction, and depressive symptoms, as well as place of residence, school/work attendance, rehospitalization, and presence of pressure ulcers. RESULTS Consistent with 1-year findings, patient characteristics continue to be strong predictors of outcomes 5-years post-injury, although several variables add to the prediction of some of the outcomes. More time in physical therapy and therapeutic recreation were positive predictors of 1-year outcomes, which held less true at 5 years. Greater time spent with psychology and social work/case management predicted greater depressive symptomatology 5-years post-injury. Greater clinician experience was a predictor at both 1- and 5 -years, although the related positive outcomes varied across years. CONCLUSION Various outcomes 5-years post-injury were primarily explained by pre-and post-injury characteristics, with little additional variance offered by the quantity of treatment received during inpatient rehabilitation.
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Affiliation(s)
- Kimberley R. Monden
- Craig Hospital, Englewood, Colorado, USA
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | | | - Flora M. Hammond
- Department of Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
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Lamontagne ME, Gagnon C, Allaire AS, Noreau L. A Scoping Review of Clinical Practice Improvement Methodology Use in Rehabilitation. Rehabil Process Outcome 2016. [DOI: 10.4137/rpo.s20360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Context The Clinical Practice Improvement (CPI) approach is a methodological and quality improvement approach that has emerged and is gaining in popularity. However, there is no systematic description of its use or the determinants of its practice in rehabilitation settings. Method We performed a scoping review of the use of CPI methodology in rehabilitation settings. Results A total of 103 articles were reviewed. We found evidence of 13 initiatives involving CPI with six different populations. A total of 335 citations of determinants were found, with 68.7% related to CPI itself. Little information was found about what type of external and internal environment, individual characteristics and implementation process might facilitate or hinder the use of CPI. Conclusion Given the growing popularity of this methodological approach, CPI initiatives would gain from increasing knowledge of the determinants of its success and incorporating them in future implementation.
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Affiliation(s)
- Marie-Eve Lamontagne
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, L'Institut de réadaptation en déficience physique de Québec, Québec, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Cynthia Gagnon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Neuromuscular Clinic, Centre de réadaptation en déficience physique de Jonquière, Centre de santé et de services sociaux de Jonquière, Jonquière, QC, Canada
| | - Anne-Sophie Allaire
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, L'Institut de réadaptation en déficience physique de Québec, Québec, QC, Canada
| | - Luc Noreau
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, L'Institut de réadaptation en déficience physique de Québec, Québec, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada
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Whalley B, Thompson DR, Taylor RS. Psychological interventions for coronary heart disease: cochrane systematic review and meta-analysis. Int J Behav Med 2014. [PMID: 23179678 DOI: 10.1007/s12529-012-9282-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Depression and anxiety are common in cardiac patients, and psychological interventions may also be used as part of general cardiac rehabilitation programs. PURPOSE This study aims to estimate effects of psychological interventions on mortality and psychological symptoms in this group, updating an existing Cochrane Review. METHOD Systematic review and meta-regression analyses of randomized trials evaluating a psychological treatment delivered by trained staff to patients with a diagnosed cardiac disease, with a follow-up of at least 6 months, were used. RESULTS There was no strong evidence that psychological intervention reduced total deaths, risk of revascularization, or non-fatal infarction. Psychological intervention did result in small/moderate improvements in depression and anxiety, and there was a small effect for cardiac mortality. CONCLUSION Psychological treatments appear effective in treating patients with psychological symptoms of coronary heart disease. Uncertainty remains regarding the subgroups of patients who would benefit most from treatment and the characteristics of successful interventions.
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Affiliation(s)
- Ben Whalley
- School of Psychology, University of Plymouth, Plymouth, UK
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Zanca JM, Dijkers MP. Describing What We Do: A Qualitative Study of Clinicians' Perspectives on Classifying Rehabilitation Interventions. Arch Phys Med Rehabil 2014; 95:S55-65.e2. [DOI: 10.1016/j.apmr.2013.03.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/07/2013] [Accepted: 03/07/2013] [Indexed: 10/25/2022]
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Tian W, Hsieh CH, DeJong G, Backus D, Groah S, Ballard PH. Role of body weight in therapy participation and rehabilitation outcomes among individuals with traumatic spinal cord injury. Arch Phys Med Rehabil 2013; 94:S125-36. [PMID: 23527768 DOI: 10.1016/j.apmr.2012.10.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 10/10/2012] [Accepted: 10/26/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine the association between body weight, therapy participation, and functional outcomes among people with spinal cord injury (SCI). DESIGN Multisite prospective observational cohort study. SETTING Six acute rehabilitation facilities. PARTICIPANTS Patients (N=1017) aged ≥ 12 years admitted for their initial rehabilitation after SCI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Motor FIM at inpatient rehabilitation discharge and 1 year postinjury. RESULTS Underweight and overweight/obese patients consisted of 2 different clusters of SCI patients. Underweight patients were more likely to be younger, black, less educated, single, have Medicaid as a primary payer, and more likely to have had a cervical level injury because of violence and vehicular-related events than their overweight and obese counterparts. We found few significant differences in hours of therapy during inpatient rehabilitation across weight groups. Among patients with C5-8 ASIA Impairment Scale (AIS) grades A, B, and C injuries, underweight patients received fewer hours of physical therapy per week than patients with a healthy weight (P=.028). Obese patients with paraplegia AIS grades A, B, and C received more hours of occupational therapy during their rehabilitation stay (P<.001) than other weight groups. A higher percentage of underweight patients had pressure ulcers during inpatient rehabilitation in C5-8 AIS grades A, B, and C and paraplegia AIS grades A, B, and C groups. Only in the paraplegia AIS grades A, B, and C group did we find a significant association between weight groups and discharge motor FIM score. Regression models showed that among C1-4 AIS grades A, B, and C patients, the overweight group had better 1-year follow-up motor FIM scores than other weight groups. CONCLUSIONS Patients who had an unhealthy body weight, that is, being underweight or obese, often have therapy participation and profiles different from those deemed healthy, or just overweight. For patients with paraplegia AIS grades A, B, and C, being overweight or obese was associated with diminished motor FIM outcomes at discharge from rehabilitation. The relation between body weight status, therapy participation, and outcomes are not consistent among study group participants.
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Affiliation(s)
- Wenqiang Tian
- Center for Post-acute Innovation andResearch, MedStar National Rehabilitation Hospital, Washington, DC 20010, USA.
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Backus D, Gassaway J, Smout RJ, Hsieh CH, Heinemann AW, DeJong G, Horn SD. Relation between inpatient and postdischarge services and outcomes 1 year postinjury in people with traumatic spinal cord injury. Arch Phys Med Rehabil 2013; 94:S165-74. [PMID: 23527772 DOI: 10.1016/j.apmr.2013.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/27/2012] [Accepted: 01/07/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the association between inpatient and postdischarge rehabilitation services and function, life satisfaction, and community participation 1 year after spinal cord injury (SCI). DESIGN Prospective, observational. SETTING Six rehabilitation facilities. PARTICIPANTS Patients with SCI (N=1376). INTERVENTIONS None. MAIN OUTCOME MEASURES Satisfaction with Life Scale (SWLS), Craig Handicap Assessment and Reporting Technique (CHART), motor FIM (mFIM), and return to work/school at 1 year post-SCI. RESULTS Demographic and injury characteristics explained 49% of the variance in mFIM and 9% to 25% of the variance in SWLS and CHART social integration, mobility, and occupation scores. Inpatient rehabilitation services explained an additional 2% of the variance for mFIM and 1% to 3% of the variance for SWLS and CHART scores. More time in inpatient physical therapy (PT) was associated with higher mFIM scores; more time in inpatient therapeutic recreation (TR) and social work and more postdischarge nursing (NSG) were associated with lower mFIM scores. More inpatient PT and TR and more postdischarge PT were associated with higher mobility scores; more inpatient psychology (PSY) was associated with lower mobility scores. More postdischarge TR was associated with higher SWLS; more postdischarge PSY services was associated with lower SWLS. Inpatient TR was positively associated with social integration scores; postdischarge PSY was negatively associated with social integration scores. More postdischarge vocational counseling was associated with higher occupation scores. Differences between centers did not explain additional variability in the outcomes studied. CONCLUSIONS Inpatient and postdischarge rehabilitation services are weakly associated with life satisfaction and societal participation 1 year after SCI. Further study of the type and intensity of postdischarge services, and the association with outcomes, is needed to ascertain the most effective use of therapy services after SCI.
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Affiliation(s)
- Deborah Backus
- Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA.
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DeJong G, Tian W, Hsieh CH, Junn C, Karam C, Ballard PH, Smout RJ, Horn SD, Zanca JM, Heinemann AW, Hammond FM, Backus D. Rehospitalization in the first year of traumatic spinal cord injury after discharge from medical rehabilitation. Arch Phys Med Rehabil 2013; 94:S87-97. [PMID: 23527776 DOI: 10.1016/j.apmr.2012.10.037] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 09/27/2012] [Accepted: 10/30/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine rates of rehospitalization among discharged rehabilitation patients with traumatic spinal cord injury (SCI) in the first 12 months postinjury, and to identify factors associated with rehospitalization. DESIGN Prospective observational cohort study. SETTING Six geographically dispersed rehabilitation centers in the U.S. PARTICIPANTS Consecutively enrolled individuals with new traumatic SCI (N=951), who were discharged from participating rehabilitation centers and participated in a 1-year follow-up survey. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Occurrence of postrehabilitation rehospitalization within 1 year of injury, length of rehospitalization stays, and causes of rehospitalizations. RESULTS More than one third (36.2%) of participants were rehospitalized at least once in the 12-month follow-up period; 12.5% were rehospitalized at least twice. The average number of rehospitalizations among those rehospitalized at least once was 1.37 times, with an average length of stay (LOS) of 15.5 days across all rehospitalization episodes. The 3 most common health conditions associated with rehospitalization were those related to the genitourinary system (eg, urinary tract infection), respiratory system (eg, pneumonia), and skin and subcutaneous tissue (eg, pressure ulcer). Being a woman (95% confidence interval [CI], 1.034-2.279), having Medicaid as the main payer (95% CI, 1.303-2.936), and more severe case mix were associated with increased odds of rehospitalization. Those who had more intensive physical therapy (95% CI, .960-.981) had lower odds of rehospitalization. Some center-to-center variation in rehospitalization rates remained unexplained after case mix and practice differences were considered. The 6 SCI rehabilitation centers varied nearly 2-fold in rates at which their former SCI patients were rehospitalized--from 27.8% to 50%. Center-to-center variation diminished when patient case mix was considered. CONCLUSIONS Compared with earlier studies, rehospitalization rates among individuals with SCI in the first postinjury year remain high and vary by level and completeness of injury. Rehospitalization risk was associated with younger age, being a woman, unemployment and retirement, and Medicaid coverage. Those who had more intensive physical therapy had lower odds of rehospitalization. Future studies should examine center-to-center variations in rehospitalization rates and availability of patient education and community resources.
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Affiliation(s)
- Gerben DeJong
- Center for Post-acute Innovation & Research, MedStar National Rehabilitation Hospital, Washington, DC 20010, USA.
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Zanca JM, Dijkers MP, Hsieh CH, Heinemann AW, Horn SD, Smout RJ, Backus D. Group therapy utilization in inpatient spinal cord injury rehabilitation. Arch Phys Med Rehabil 2013; 94:S145-53. [PMID: 23527770 DOI: 10.1016/j.apmr.2012.11.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 11/13/2012] [Accepted: 11/26/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe group therapy utilization in spinal cord injury (SCI) inpatient rehabilitation. DESIGN Prospective observational study. SETTING Six inpatient rehabilitation facilities. PARTICIPANTS Patients (N=1376) receiving initial rehabilitation after traumatic SCI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Time spent in group versus individual therapy for physical therapy (PT), occupational therapy (OT), therapeutic recreation (TR), and psychology (PSY) therapies. RESULTS The majority (98%) of patients participated in at least 1 group therapy session, with 83%, 81%, 80%, and 54% of patients receiving group PT, OT, TR, and PSY, respectively. On average, 24% of treatment sessions and 27% of treatment time was provided in group sessions, with TR providing the greatest percent of its time in groups. Group therapy time and time spent in specific activities varied among patient subgroups with different injury characteristics. Group therapy time also varied widely among centers (range, 1.2-6.6h/wk). Across all injury subgroups, individual and group therapy hours per week were negatively correlated for OT and positively correlated for TR. Patient characteristics, clinician experience, and treatment center predicted 32% of variance in group hours per week. PT and OT strengthening/endurance interventions and TR outings were the most common group activities overall. CONCLUSIONS While the majority of inpatient SCI rehabilitation consists of individual sessions, most patients participate in group therapy, which contributes significantly to total therapy time. Patterns of group utilization fit with functional expectations and clinical goals. A trade-off between group and individual therapy may occur in some disciplines. Utilization of group therapy varies widely among centers, and further study is needed to identify optimal patterns of group therapy utilization.
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Affiliation(s)
- Jeanne M Zanca
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY, USA.
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CER, PBE, SCIRehab, NIDRR, and other important abbreviations. Arch Phys Med Rehabil 2013; 94:S61-6. [PMID: 23527774 DOI: 10.1016/j.apmr.2012.11.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 11/01/2012] [Accepted: 11/09/2012] [Indexed: 11/23/2022]
Abstract
Comparative effectiveness research (CER) has been receiving much attention (and government funding) in recent years, stemming from dissatisfaction with much medical and health care research, which does not produce actionable evidence that can be used by clinicians, patients, and policymakers. Rehabilitation research has been characterized by similar weaknesses and by often inadequate research designs. The SCIRehab study of the outcomes of inpatient spinal cord injury rehabilitation is one of a small number of rehabilitation practice-based evidence (PBE) studies in recent years that allows for the comparison of interventions by all disciplines for relevant real-life outcomes. This introduction to a series of articles resulting from the SCIRehab project discusses the need for and the nature of CER, and places the SCIRehab study and other PBE studies in the light of CER. After a description of the highlights of the analyses in this supplement, we provide a preliminary evaluation of SCIRehab, counting the articles and presentations from the study, the resources that went into this vast project, and the lessons learned that may benefit future rehabilitation PBE investigators.
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Comparing Rehabilitation Services and Outcomes Between Older and Younger People With Spinal Cord Injury. Arch Phys Med Rehabil 2013; 94:S175-86. [DOI: 10.1016/j.apmr.2012.10.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 10/08/2012] [Accepted: 10/09/2012] [Indexed: 11/22/2022]
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SCIRehab Uses Practice-Based Evidence Methodology to Associate Patient and Treatment Characteristics With Outcomes. Arch Phys Med Rehabil 2013; 94:S67-74. [DOI: 10.1016/j.apmr.2012.12.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 12/15/2012] [Accepted: 12/17/2012] [Indexed: 11/21/2022]
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Dijkers MP, Zanca JM. Factors Complicating Treatment Sessions in Spinal Cord Injury Rehabilitation: Nature, Frequency, and Consequences. Arch Phys Med Rehabil 2013; 94:S115-24. [DOI: 10.1016/j.apmr.2012.11.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 11/09/2012] [Accepted: 11/12/2012] [Indexed: 11/26/2022]
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Zanca JM, Dijkers MP, Hammond FM, Horn SD. Pain and Its Impact on Inpatient Rehabilitation for Acute Traumatic Spinal Cord Injury: Analysis of Observational Data Collected in the SCIRehab Study. Arch Phys Med Rehabil 2013; 94:S137-44. [DOI: 10.1016/j.apmr.2012.10.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 08/25/2012] [Accepted: 10/30/2012] [Indexed: 10/27/2022]
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Heinemann AW, Wilson CS, Huston T, Koval J, Gordon S, Gassaway J, Kreider SE, Whiteneck G. Relationship of psychology inpatient rehabilitation services and patient characteristics to outcomes following spinal cord injury: the SCIRehab project. J Spinal Cord Med 2012; 35:578-92. [PMID: 23318038 PMCID: PMC3522898 DOI: 10.1179/2045772312y.0000000059] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT AND OBJECTIVE To evaluate the effects of psychological interventions on rehabilitation outcomes, including residence and functional status at discharge, and residence, school attendance, or employment, and physical, social, occupational, and mobility aspects of participation 1 year after spinal cord injury (SCI). DESIGN Prospective observational cohort study. SETTING Six inpatient rehabilitation facilities in the United States. PARTICIPANTS Inpatients with SCI 12 years of age and older. INTERVENTIONS Usual rehabilitation care. OUTCOME MEASURES Functional Independence Measure at rehabilitation discharge and 1-year injury anniversary; discharge destination and residence at 1-year anniversary; Craig Handicap Assessment and Reporting Technique, Diener Satisfaction with Life Scale, Patient Health Questionnaire, employment or school attendance, rehospitalization, and occurrence of a pressure ulcer at 1-year anniversary. RESULTS More time in psycho-educational interventions was associated with better function, discharge to home, home residence at 1 year, and the absence of pressure ulcers at 1 year. More psychotherapeutic sessions focusing on processing emotions and/or locus of control were associated with poorer function at discharge and 1 year, less physical independence and community mobility, lower satisfaction with life, and the presence of pressure sores at 1 year. CONCLUSIONS Psychological services are an important component of comprehensive medical rehabilitation and tailored to patient needs and readiness to benefit from rehabilitation. Services focused on remediating deficits tend to be associated with negative outcomes, while services intended to foster adjustment and growth tend to be associated with favorable outcomes. Further research is needed to determine the optimal type and timing of psychological services during inpatient rehabilitation based on individuals' strengths and vulnerabilities. Note: This is the sixth in this third series of SCIRehab articles.
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Affiliation(s)
| | - Catherine S. Wilson
- Rehabilitation Institute of Chicago, Chicago, IL, USA; and James A. Haley Veterans Hospital, Tampa, FL, USA
| | | | | | - Samuel Gordon
- MedStar National Rehabilitation Hospital, Washington, DC, USA
| | - Julie Gassaway
- Institute for Clinical Outcomes Research, Salt Lake City, UT, USA
| | | | - Gale Whiteneck
- Craig Hospital, Englewood, CO, USA,Correspondence to: Gale Whiteneck, Craig Hospital, 3425 S. Clarkson St, Englewood, CO 80113.
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Dijkers MP, Faotto RM. Team size in spinal cord injury inpatient rehabilitation and patient participation in therapy sessions: the SCIRehab project. J Spinal Cord Med 2012; 35:624-34. [PMID: 23318041 PMCID: PMC3522901 DOI: 10.1179/2045772312y.0000000065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT/OBJECTIVE Rehabilitation teams generally are described as consisting of a single representative of 6-8 disciplines, but research suggests that the number of individuals involved may be much larger. This study aimed to determine the size of teams in spinal cord injury (SCI) rehabilitation, and the effect of team size on patients' active participation in their treatment sessions. DESIGN Prospective observational study. SETTING Six SCI rehabilitation centers. PARTICIPANTS A total of 1376 patients with traumatic SCI admitted for first rehabilitation. INTERVENTIONS Not applicable. OUTCOME MEASURES Number of treatment sessions, by discipline and overall clinician rating of active participation of the patient; Treatment Concentration Index (TCI) calculated as Σp(k)(2) (where p refers to the proportion of treatment sessions delivered by team member k). RESULTS The average patient was treated by 39.3 different clinicians. The numbers were especially high for physical therapy (mean: 8.8), occupational therapy (7.2), and nursing (16.1). TCI was 0.08 overall; it varied by discipline. TCI was negatively correlated with length of stay, except for psychology. Participation ratings were minimally affected by the number of sessions the patient and the therapist had worked together. CONCLUSIONS In SCI rehabilitation, teams are at least as large as suggested by previous research. However, this may not mean lack of familiarity of patient and therapist with one another, or alternatively, the possibly weak therapeutic alliance does not affect the patients' active participation in their sessions. Further research is needed to determine whether there are negative effects on rehabilitation outcomes.
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Affiliation(s)
- Marcel P. Dijkers
- Mount Sinai School of Medicine, New York, NY, USA,Correspondence to: Dr Marcel Dijkers, Associate Professor, Rehab Medicine, Mt. Sinai School of Medicine, One Gustave Levy Place, NY USA, Box 1240.
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Whiteneck G, Gassaway J, Dijkers MP, Heinemann AW, Kreider SED. Relationship of patient characteristics and rehabilitation services to outcomes following spinal cord injury: the SCIRehab project. J Spinal Cord Med 2012; 35:484-502. [PMID: 23318033 PMCID: PMC3522893 DOI: 10.1179/2045772312y.0000000057] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND/OBJECTIVE To examine associations of patient characteristics along with treatment quantity delivered by seven clinical disciplines during inpatient spinal cord injury (SCI) rehabilitation with outcomes at rehabilitation discharge and 1-year post-injury. METHODS Six inpatient SCI rehabilitation centers enrolled 1376 patients during the 5-year SCIRehab study. Clinicians delivering standard care documented details of treatment. Outcome data were derived from SCI Model Systems Form I and II and a project-specific interview conducted at approximately 1-year post-injury. Regression modeling was used to predict outcomes; models were cross-validated by examining relative shrinkage of the original model R(2) using 75% of the dataset to the R(2) for the same outcome using a validation subsample. RESULTS Patient characteristics are strong predictors of outcome; treatment duration adds slightly more predictive power. More time in physical therapy was associated positively with motor Functional Independence Measure at discharge and the 1-year anniversary, CHART Physical Independence, Social Integration, and Mobility dimensions, and smaller likelihood of rehospitalization after discharge and reporting of pressure ulcer at the interview. More time in therapeutic recreation also had multiple similar positive associations. Time spent in other disciplines had fewer and mixed relationships. Seven models validated well, two validated moderately well, and four validated poorly. CONCLUSION Patient characteristics explain a large proportion of variation in multiple outcomes after inpatient rehabilitation. The total amount of treatment received during rehabilitation from each of seven disciplines explains little additional variance. Reasons for this and the phenomenon that sometimes more hours of service predict poorer outcome, need additional study. Note: This is the first of nine articles in the SCIRehab series.
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Affiliation(s)
- Gale Whiteneck
- Department of Research, Craig Hospital, Englewood, CO, USA.
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Abstract
STUDY DESIGN Review. OBJECTIVES To review literature on subjective well-being (SWB; mental health and life satisfaction) and on psychological and social support factors associated with these outcomes in people with spinal cord injury (SCI), in order to identify gaps in scientific knowledge and recommend research priorities. SETTING Non applicable. METHODS Narrative review of the SCI literature on life satisfaction and mental health (depression, anxiety, post-traumatic stress syndrome) outcomes in people with SCI. Further, reviews were performed of the SCI literature on psychological and social support variables associated with SWB and on psychosocial interventions aimed to improve SWB. RESULTS People with SCI experience, on average, higher levels of distress and lower levels of life satisfaction compared with the general population. Individual differences, however, are large, and most people with SCI adapt well to their condition. A set of psychological and social support factors is strongly related to SWB. Intervention studies on cognitive behavioural therapy or coping effectiveness training to improve SWB show promising results, but suffer from methodological weaknesses (for example, lack of randomization and small sample size). CONCLUSION There is a need for cohort studies with sufficient sample size, which include people early after onset of SCI in order to enhance our understanding of the course of mental health and well-being after SCI. Cohort studies could also identify which people are at risk for long-term impairment of SWB. Finally, intervention studies on psychosocial interventions are needed to identify which interventions may improve SWB of people with SCI.
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Whiteneck GG, Gassaway J, Dijkers MP, Lammertse DP, Hammond F, Heinemann AW, Backus D, Charlifue S, Ballard PH, Zanca JM. Inpatient and Postdischarge Rehabilitation Services Provided in the First Year After Spinal Cord Injury: Findings From the SCIRehab Study. Arch Phys Med Rehabil 2011; 92:361-8. [DOI: 10.1016/j.apmr.2010.07.241] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 05/24/2010] [Accepted: 07/06/2010] [Indexed: 11/26/2022]
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Taylor-Schroeder S, LaBarbera J, McDowell S, Zanca JM, Natale A, Mumma S, Gassaway J, Backus D. The SCIRehab project: treatment time spent in SCI rehabilitation. Physical therapy treatment time during inpatient spinal cord injury rehabilitation. J Spinal Cord Med 2011; 34:149-61. [PMID: 21675354 PMCID: PMC3066500 DOI: 10.1179/107902611x12971826988057] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 08/30/2010] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND/OBJECTIVE To describe the nature and distribution of activities during physical therapy (PT) delivered in inpatient spinal cord injury (SCI) rehabilitation and discuss predictors (patient and injury characteristics) of the amount of time spent in PT for specific treatment activities. METHODS Six hundred patients from six inpatient SCI centers were enrolled in the SCIRehab study. Physical therapists documented details, including time spent, of treatment provided during 37 306 PT sessions that occurred during inpatient SCI rehabilitation. Ordinary least squares regression models associated patient and injury characteristics with time spent in specific PT activities. RESULTS SCIRehab patients received a mean total of 55.3 hours of PT over the course of their rehabilitation stay. Significant differences among four neurologic groups were seen in the amount of time spent on most activities, including the most common PT activities of strengthening exercises, stretching, transfer training, wheelchair mobility training, and gait training. Most PT work (77%) was provided in individual therapy sessions; the remaining 23% was done in group settings. Patient and injury characteristics explained only some of the variations seen in time spent on wheelchair mobility, transfer and bed mobility training, and range of motion/ stretching. CONCLUSION Analysis yielded both expected and unexpected trends in SCI rehabilitation. Significant variation was seen in time spent on PT activities within and among injury groups. Providing therapeutic strengthening treatments consumed the greatest proportion of PT time. About one-quarter of all PT services were provided in group settings. Details about services provided, including time spent, will serve as a starting point in detailing the optimal treatment delivery for maximal outcomes.
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Affiliation(s)
| | | | | | | | | | - Sherry Mumma
- National Rehabilitation Hospital, Washington, DC, USA
| | - Julie Gassaway
- Institute for Clinical Outcomes Research, Salt Lake City, UT, USA
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Geyh S, Peter C, Müller R, Stucki G, Cieza A. Translating Topics in SCI Psychology Into theInternational Classification of Functioning, Disability and Health. Top Spinal Cord Inj Rehabil 2011. [DOI: 10.1310/sci1603-104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Whiteneck G, Gassaway J, Dijkers MP, Hammond FM, Lammertse DP. The SCIRehab project: analyzing multidisciplinary inpatient spinal cord injury rehabilitation treatment--second phase. J Spinal Cord Med 2011; 34:131-2. [PMID: 21675352 PMCID: PMC3066507 DOI: 10.1179/107902611x12971826987977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 09/26/2010] [Indexed: 10/31/2022] Open
Affiliation(s)
- Gale Whiteneck
- Rocky Mountain Regional Spinal Injury System, Craig Hospital, Englewood, CO, USA
| | - Julie Gassaway
- Institute for Clinical Outcomes Research, Salt Lake City, UT, USA
| | - Marcel P. Dijkers
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Flora M. Hammond
- Carolinas Rehabilitation, Charlotte, NC, USA
- Indiana University, Indianapolis, IN, USA
| | - Daniel P. Lammertse
- Rocky Mountain Regional Spinal Injury System, Craig Hospital, Englewood, CO, USA
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Huston T, Gassaway J, Wilson C, Gordon S, Koval J, Schwebel A. The SCIRehab project: treatment time spent in SCI rehabilitation. Psychology treatment time during inpatient spinal cord injury rehabilitation. J Spinal Cord Med 2011; 34:196-204. [PMID: 21675358 PMCID: PMC3066506 DOI: 10.1179/107902611x12971826988219] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 08/30/2010] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Rehabilitation psychologists are integral members of spinal cord injury (SCI) rehabilitation teams. OBJECTIVE To describe specific information regarding types and intensity of treatments delivered by rehabilitation psychologists to patients with various levels of SCI. METHODS Utilizing a taxonomy of psychological interventions as a framework, rehabilitation psychologists documented time spent on specific psychology interventions for each interaction they had with 600 patients with traumatic SCI at 6 inpatient SCI rehabilitation centers. Associations of patient and injury characteristics with time spent on various psychological interventions were examined using ordinary least squares stepwise regression models. RESULTS Psychologists focus the majority of the time they spend with patients with SCI on psychotherapeutic interventions of processing emotions, emotional adjustment, and family coping, while educational efforts focus mostly on coping and adjusting to the new injury. There was wide variation in the amount of time spent on psychotherapeutic and psychoeducational interventions; patient, injury, and clinician characteristics explained little of the variation in time spent. CONCLUSIONS Variations observed in psychological treatment delivery mirror real-world human complexity and clinical experience; they are not explained well by patient and injury characteristics and set the stage for future analyses to associate treatments with outcomes.
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Affiliation(s)
| | - Julie Gassaway
- Institute for Clinical Outcomes Research, Salt Lake City, UT, USA
| | - Catherine Wilson
- Rehabilitation Institute of Chicago, Chicago, IL, USA
- James A. Haley Veterans Hospital, Tampa, FL, USA
| | - Samuel Gordon
- National Rehabilitation Hospital, Washington, DC, USA
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Whiteneck G, Gassaway J, Dijkers M, Backus D, Charlifue S, Chen D, Hammond F, Hsieh CH, Smout RJ. The SCIRehab project: treatment time spent in SCI rehabilitation. Inpatient treatment time across disciplines in spinal cord injury rehabilitation. J Spinal Cord Med 2011; 34:133-48. [PMID: 21675353 PMCID: PMC3066504 DOI: 10.1179/107902611x12971826988011] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 08/30/2010] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND/OBJECTIVE Length of stay (LOS) for rehabilitation treatment after spinal cord injury (SCI) has been documented extensively. However, there is almost no published research on the nature, extent, or intensity of the various treatments patients receive during their stay. This study aims at providing such information on a large sample of patients treated by specialty rehabilitation inpatient programs. METHODS Six hundred patients with traumatic SCI admitted to six rehabilitation centers were enrolled. Time spent on various therapeutic activities was documented by each rehabilitation clinician after each patient encounter. Patients were grouped by neurologic level and completeness of injury. Total time spent by each rehabilitation discipline over a patient's stay and total minutes of treatment per week were calculated. Ordinary least squares stepwise regression models were used to identify patient and injury characteristics associated with time spent in rehabilitation treatment overall and within each discipline. RESULTS Average LOS was 55 days (standard deviation 37), during which 180 (106) hours of treatment were received, or 24 (5) hours per week. Extensive variation was found in the amount of treatment received, between and within neurologic groups. Total hours of treatment provided throughout a patient's stay were primarily determined by LOS, which in turn was primarily predicted by medical acuity. Variation in minutes per week of treatment delivered by individual disciplines was predicted poorly by patient and injury characteristics. CONCLUSIONS Variations between and within SCI rehabilitation patient groups in LOS, minutes of treatment per week overall, and for each rehabilitation discipline are large. Variation in treatment intensity was not well explained by patient and injury characteristics. In accordance with practice-based evidence methodology, the next step in the SCIRehab study will be to determine which treatment interventions are related with positive outcomes (at 1 year post injury), after controlling for patient and injury differences.
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Affiliation(s)
- Gale Whiteneck
- Rocky Mountain Regional Spinal Injury System, Craig Hospital, Englewood, CO, USA
| | - Julie Gassaway
- Institute for Clinical Outcomes Research, Salt Lake City, UT, USA
| | - Marcel Dijkers
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Deborah Backus
- Shepherd Center, Atlanta, GA, USA
- Emory University School of Medicine, Atlanta, GA, USA
| | - Susan Charlifue
- Rocky Mountain Regional Spinal Injury System, Craig Hospital, Englewood, CO, USA
| | - David Chen
- Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Flora Hammond
- Carolinas Rehabilitation, Charlotte, NC, USA
- Indiana University, Indianapolis, IN, USA
| | - Ching-Hui Hsieh
- Center for Post-acute Studies, National Rehabilitation Hospital, Washington, DC, USA
| | - Randall J. Smout
- Institute for Clinical Outcomes Research, Salt Lake City, UT, USA
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Whiteneck G, Gassaway J. SCIRehab: a model for rehabilitation research using comprehensive person, process and outcome data. Disabil Rehabil 2010; 32:1035-42. [DOI: 10.3109/09638281003775584] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gassaway J, Whiteneck G, Dijkers M. Clinical taxonomy development and application in spinal cord injury research: the SCIRehab Project. J Spinal Cord Med 2009; 32:260-9. [PMID: 19810628 PMCID: PMC2718825 DOI: 10.1080/10790268.2009.11760780] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Applying practice-based evidence research methodology to spinal cord injury (SCI) rehabilitation requires taxonomy (typology or classification) of rehabilitation interventions provided by every discipline contributing to SCI rehabilitation. The rehabilitation field currently lacks such taxonomy. METHODS SCIRehab project researchers and clinicians representing 7 rehabilitation disciplines from 6 US inpatient SCI rehabilitation facilities worked in discipline groups during 2 face-to-face meetings and weekly discipline-specific teleconferences for 9 months to identify key contributions of each discipline to SCI rehabilitation and to develop a classification of treatment interventions used by each discipline. These clinician groups were charged with designing documentation systems that collected enough details to describe treatment adequately while not imposing an unrealistic data collection burden on clinicians. Completed documentation systems were programmed onto handheld personal digital assistants (PDAs) to facilitate data entry by clinicians at the point of care. RESULTS Seven discipline-specific SCI rehabilitation taxonomies were developed that describe and quantify intervention activities (major categories of treatment offered by the discipline) and the activity-specific details (variables deemed important to fully describe the interventional process). Much treatment information is unique to each discipline; some is common across disciplines. CONCLUSIONS The taxonomies provide a format with which clinicians document actual interventions performed with or for patients. The SCIRehab project has developed the first comprehensive multidisciplinary taxonomy for describing the details of the SCI rehabilitation process and designed a PDA-based documentation system based on that taxonomy that allows clinicians to describe the specifics of their interactions with their patients.
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Affiliation(s)
- Julie Gassaway
- Institute for Clinical Outcomes Research, Salt Lake City, UT 84102, USA.
| | - Gale Whiteneck
- 1Institute for Clinical Outcomes Research, Salt Lake City, Utah; 2Craig Hospital, Englewood, Colorado; 3Mt. Sinai School of Medicine, Department of Rehabilitation Medicine, New York, New York
| | - Marcel Dijkers
- 1Institute for Clinical Outcomes Research, Salt Lake City, Utah; 2Craig Hospital, Englewood, Colorado; 3Mt. Sinai School of Medicine, Department of Rehabilitation Medicine, New York, New York
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Whiteneck G, Gassaway J, Dijkers M, Jha A. New approach to study the contents and outcomes of spinal cord injury rehabilitation: the SCIRehab Project. J Spinal Cord Med 2009; 32:251-9. [PMID: 19810627 PMCID: PMC2718827 DOI: 10.1080/10790268.2009.11760779] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Limited research evidence is available to show the effectiveness of the many specific interventions provided in spinal cord injury (SCI) rehabilitation; what is available typically focuses on effects of the full rehabilitation package but not specific therapy interventions, medical procedures, patient education, or counseling. Given the problems of conducting randomized controlled trials (RCTs) in rehabilitation, practice-based evidence (PBE) research has been suggested as an alternative methodology for identifying which rehabilitation interventions are associated most strongly with positive outcomes, after controlling for patient differences. Using the PBE research methodology, the SCIRehab project attempts to "open the black box" of acute SCI rehabilitation, provide detailed information on treatments delivered by all rehabilitation disciplines, and contribute to outcomes-based guidelines for clinical decision-making. METHODS The SCIRehab project includes 1,500 patients with acute SCI, consecutively admitted to 1 of 6 US inpatient rehabilitation facilities. Details of the rehabilitation process are captured by clinicians from multiple disciplines documenting their interventions in handheld personal digital assistants after sessions with their patients. Outcome data are abstracted from medical records (clinical outcomes data) and obtained from patient interviews at 6 and 12 months after injury. Extensive patient, injury, and other treatment characteristics are abstracted from medical records. SCIRehab is the first research project to collect detailed information on individual interventions offered by the full rehabilitation team. RESULTS SCIRehab is the first research project to collect detailed information on individual interventions offered by the full rehabilitation team. These findings are presented in a series of 9 articles. CONCLUSIONS To date, SCIRehab's major contribution is a system for categorizing specific contributions of each discipline and a technology for documenting that detail. After data collection is complete, future manuscripts will relate those process elements to outcomes. The SCIRehab Project is an important step toward establishing outcomes-based guidelines for SCI rehabilitation.
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Affiliation(s)
- Gale Whiteneck
- 1Craig Hospital, Englewood, Colorado; 2Institute for Clinical Outcomes Research, Salt Lake City, Utah; 3Mt. Sinai School of Medicine, Department of Rehabilitation Medicine, New York, New York
| | - Julie Gassaway
- 1Craig Hospital, Englewood, Colorado; 2Institute for Clinical Outcomes Research, Salt Lake City, Utah; 3Mt. Sinai School of Medicine, Department of Rehabilitation Medicine, New York, New York
| | - Marcel Dijkers
- 1Craig Hospital, Englewood, Colorado; 2Institute for Clinical Outcomes Research, Salt Lake City, Utah; 3Mt. Sinai School of Medicine, Department of Rehabilitation Medicine, New York, New York
| | - Amitabh Jha
- 1Craig Hospital, Englewood, Colorado; 2Institute for Clinical Outcomes Research, Salt Lake City, Utah; 3Mt. Sinai School of Medicine, Department of Rehabilitation Medicine, New York, New York
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Whiteneck G, Dijkers M, Gassaway J, Lammertse DP. The SCIRehab Project: classification and quantification of spinal cord injury rehabilitation treatments. Preface. J Spinal Cord Med 2009; 32:249-50. [PMID: 19810626 PMCID: PMC2718826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Affiliation(s)
- Gale Whiteneck
- 1Craig Hospital, Englewood, Colorado; 2Mt. Sinai School of Medicine, New York, New York; 3Institute for Clinical Outcomes Research, Salt Lake City, Utah
| | - Marcel Dijkers
- 1Craig Hospital, Englewood, Colorado; 2Mt. Sinai School of Medicine, New York, New York; 3Institute for Clinical Outcomes Research, Salt Lake City, Utah
| | - Julie Gassaway
- 1Craig Hospital, Englewood, Colorado; 2Mt. Sinai School of Medicine, New York, New York; 3Institute for Clinical Outcomes Research, Salt Lake City, Utah
| | - Daniel P Lammertse
- 1Craig Hospital, Englewood, Colorado; 2Mt. Sinai School of Medicine, New York, New York; 3Institute for Clinical Outcomes Research, Salt Lake City, Utah
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