A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Rehabilitation

Michael G Fehlings, Lindsay A Tetreault, Bizhan Aarabi, Paul Anderson, Paul M Arnold, Darrel S Brodke, Kazuhiro Chiba, Joseph R Dettori, Julio C Furlan, James S Harrop, Gregory Hawryluk, Langston T Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Brian K Kwon, Ralph J Marino, Allan R Martin, Eric Massicotte, Geno Merli, James W Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Anoushka Singh, Andrea C Skelly, Eve C Tsai, Alexander Vaccaro, Jefferson R Wilson, Albert Yee, Anthony S Burns, Michael G Fehlings, Lindsay A Tetreault, Bizhan Aarabi, Paul Anderson, Paul M Arnold, Darrel S Brodke, Kazuhiro Chiba, Joseph R Dettori, Julio C Furlan, James S Harrop, Gregory Hawryluk, Langston T Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Brian K Kwon, Ralph J Marino, Allan R Martin, Eric Massicotte, Geno Merli, James W Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Anoushka Singh, Andrea C Skelly, Eve C Tsai, Alexander Vaccaro, Jefferson R Wilson, Albert Yee, Anthony S Burns

Abstract

Introduction: The objective of this study is to develop guidelines that outline the appropriate type and timing of rehabilitation in patients with acute spinal cord injury (SCI).

Methods: A systematic review of the literature was conducted to address key questions related to rehabilitation in patients with acute SCI. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the type and timing of rehabilitation. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as "we recommend," whereas a weaker recommendation is indicated by "we suggest.

Results: Based on the findings from the systematic review, our recommendations were: (1) We suggest rehabilitation be offered to patients with acute spinal cord injury when they are medically stable and can tolerate required rehabilitation intensity (no included studies; expert opinion); (2) We suggest body weight-supported treadmill training as an option for ambulation training in addition to conventional overground walking, dependent on resource availability, context, and local expertise (low evidence); (3) We suggest that individuals with acute and subacute cervical SCI be offered functional electrical stimulation as an option to improve hand and upper extremity function (low evidence); and (4) Based on the absence of any clear benefit, we suggest not offering additional training in unsupported sitting beyond what is currently incorporated in standard rehabilitation (low evidence).

Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in patients with SCI by promoting standardization of care, decreasing the heterogeneity of management strategies and encouraging clinicians to make evidence-informed decisions.

Keywords: acute spinal cord injury; clinical guideline; guideline; rehabilitation; spinal cord injury; traumatic spinal cord injury.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

    1. Singh A, Tetreault L, Kalsi-Ryan S, Nouri A, Fehlings MG. Global prevalence and incidence of traumatic spinal cord injury. Clin Epidemiol. 2014;6:309–331. doi:10.2147/CLEP.S68889.
    1. Shiffman RN, Michel G. Toward improved guideline quality: using the COGS statement with GEM. Stud Health Technol Inform. 2004;107:159–163.
    1. Shiffman RN, Shekelle P, Overhage JM, Slutsky J, Grimshaw J, Deshpande AM. Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization. Ann Intern Med. 2003;139:493–498.
    1. Balshem H, Helfand M, Schunemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64:401–406.
    1. Agency for Healthcare Research and Quality. Methods Guide for Effectiveness and Comparative Effectiveness Reviews (AHRQ Publication No. 10(14)-EHC063-EF). Rockville, MD: Agency for Healthcare Research and Quality; 2013.
    1. Andrews J, Guyatt G, Oxman AD, et al. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol. 2013;66:719–725. doi:10.1016/j.jclinepi.2012.03.013.
    1. Andrews JC, Schunemann HJ, Oxman AD, et al. GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation’s direction and strength. J Clin Epidemiol. 2013;66:726–735. doi:10.1016/j.jclinepi.2013.02.003.
    1. Schunemann HJ, Oxman AD, Akl EA, et al. Moving from evidence to developing recommendations in guidelines: article 11 in integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report. Proc Am Thorac Soc. 2012;9:282–292. doi:10.1513/pats.201208-064ST.
    1. Wu JC, Ko CC, Yen YS, et al. Epidemiology of cervical spondylotic myelopathy and its risk of causing spinal cord injury: a national cohort study. Neurosurg Focus. 2013;35:E10 doi:10.3171/2013.4.FOCUS13122.
    1. Teeter L, Gassaway J, Taylor S, et al. Relationship of physical therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project. J Spinal Cord Med. 2012;35:503–526. doi:10.1179/2045772312y.0000000058.
    1. Whiteneck G, Gassaway J, Dijkers MP, Heinemann AW, Kreider SE. Relationship of patient characteristics and rehabilitation services to outcomes following spinal cord injury: the SCIRehab project. J Spinal Cord Med. 2012;35:484–502. doi:10.1179/2045772312y.0000000057.
    1. Abdul-Sattar AB. Predictors of functional outcome in patients with traumatic spinal cord injury after inpatient rehabilitation: in Saudi Arabia. NeuroRehabilitation. 2014;35:341–347.
    1. Dobkin B, Barbeau H, Deforge D, et al. The evolution of walking-related outcomes over the first 12 weeks of rehabilitation for incomplete traumatic spinal cord injury: the multicenter randomized Spinal Cord Injury Locomotor Trial. Neurorehabil Neural Repair. 2007;21:25–35. doi:10.1177/1545968306295556.
    1. Lucareli PR, Lima MO, Lima FP, de Almeida JG, Brech GC, D’Andréa Greve JM. Gait analysis following treadmill training with body weight support versus conventional physical therapy: a prospective randomized controlled single blind study. Spinal Cord. 2011;49:1001–1007.
    1. Popovic MR, Kapadia N, Zivanovic V, Furlan JC, Craven BC, McGillivray C. Functional electrical stimulation therapy of voluntary grasping versus only conventional rehabilitation for patients with subacute incomplete tetraplegia: a randomized clinical trial. Neurorehabil Neural Repair. 2011;25:433–442. doi:10.1177/1545968310392924.
    1. Kohlmeyer KM, Hill JP, Yarkony GM, Jaeger RJ. Electrical stimulation and biofeedback effect on recovery of tenodesis grasp: a controlled study. Arch Phys Med Rehabil. 1996;77:702–706.
    1. Harvey LA, Ristev D, Hossain MS, et al. Training unsupported sitting does not improve ability to sit in people with recently acquired paraplegia: a randomised trial. J Physiother. 2011;57:83–90.
    1. Dobkin BH. Confounders in rehabilitation trials of task-oriented training: lessons from the designs of the EXCITE and SCILT multicenter trials. Neurorehabil Neural Repair. 2007;21:3–13. doi:10.1177/1545968306297329.
    1. Brouwers MC, Kho ME, Browman GP, et al. Development of the AGREE II, part 2: assessment of validity of items and tools to support application. CMAJ. 2010;182:E472–478. doi:10.1503/cmaj.091716.

Source: PubMed

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