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

doi:10.1177/2192568217701910

. 2017 Sep;7(3 Suppl):231S-238S.

doi: 10.1177/2192568217701910. Epub 2017 Sep 5.

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^{1

2}, Lindsay A Tetreault^{1

3}, Bizhan Aarabi⁴, Paul Anderson⁵, Paul M Arnold⁶, Darrel S Brodke⁷, Kazuhiro Chiba⁸, Joseph R Dettori⁹, Julio C Furlan^{2

10}, James S Harrop¹¹, Gregory Hawryluk⁷, Langston T Holly¹², Susan Howley¹³, Tara Jeji¹⁴, Sukhvinder Kalsi-Ryan¹, Mark Kotter¹⁵, Shekar Kurpad¹⁶, Brian K Kwon¹⁷, Ralph J Marino¹⁸, Allan R Martin¹, Eric Massicotte¹, Geno Merli¹⁹, James W Middleton²⁰, Hiroaki Nakashima²¹, Narihito Nagoshi^{1

22}, Katherine Palmieri⁶, Anoushka Singh¹, Andrea C Skelly⁹, Eve C Tsai²³, Alexander Vaccaro¹¹, Jefferson R Wilson^{2

24}, Albert Yee²⁵, Anthony S Burns¹⁰

Affiliations

¹ Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
² University of Toronto, Toronto, Ontario, Canada.
³ University College Cork, Cork, Ireland.
⁴ University of Maryland School of Medicine, Baltimore, MD, USA.
⁵ University of Wisconsin, Madison, WI, USA.
⁶ The University of Kansas, Kansas City, KS, USA.
⁷ University of Utah, Salt Lake City, UT, USA.
⁸ National Defense Medical College, Saitama, Japan.
⁹ Spectrum Research, Inc, Tacoma, WA, USA.
¹⁰ Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
¹¹ Thomas Jefferson University, Philadelphia, PA, USA.
¹² University of California at Los Angeles, Los Angeles, CA, USA.
¹³ Christopher & Dana Reeve Foundation, Short Hills, NJ, USA.
¹⁴ Ontario Neurotrauma Foundation, Toronto, Ontario, Canada.
¹⁵ University of Cambridge, Cambridge, England.
¹⁶ Medical College of Wisconsin, Milwaukee, WI, USA.
¹⁷ University of British Columbia, Vancouver, British Columbia, Canada.
¹⁸ Thomas Jefferson University Hospital, Philadelphia, PA, USA.
¹⁹ Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
²⁰ University of Sydney, Sydney, New South Wales, Australia.
²¹ Nagoya University Graduate School of Medicine, Nagoya, Japan.
²² Keio University School of Medicine, Keio, Japan.
²³ University of Ottawa, Ottawa, Ontario, Canada.
²⁴ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
²⁵ Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

PMID: 29164029
PMCID: PMC5684839
DOI: 10.1177/2192568217701910

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 et al. Global Spine J. 2017 Sep.

. 2017 Sep;7(3 Suppl):231S-238S.

doi: 10.1177/2192568217701910. Epub 2017 Sep 5.

Authors

Affiliations

¹ Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
² University of Toronto, Toronto, Ontario, Canada.
³ University College Cork, Cork, Ireland.
⁴ University of Maryland School of Medicine, Baltimore, MD, USA.
⁵ University of Wisconsin, Madison, WI, USA.
⁶ The University of Kansas, Kansas City, KS, USA.
⁷ University of Utah, Salt Lake City, UT, USA.
⁸ National Defense Medical College, Saitama, Japan.
⁹ Spectrum Research, Inc, Tacoma, WA, USA.
¹⁰ Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
¹¹ Thomas Jefferson University, Philadelphia, PA, USA.
¹² University of California at Los Angeles, Los Angeles, CA, USA.
¹³ Christopher & Dana Reeve Foundation, Short Hills, NJ, USA.
¹⁴ Ontario Neurotrauma Foundation, Toronto, Ontario, Canada.
¹⁵ University of Cambridge, Cambridge, England.
¹⁶ Medical College of Wisconsin, Milwaukee, WI, USA.
¹⁷ University of British Columbia, Vancouver, British Columbia, Canada.
¹⁸ Thomas Jefferson University Hospital, Philadelphia, PA, USA.
¹⁹ Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
²⁰ University of Sydney, Sydney, New South Wales, Australia.
²¹ Nagoya University Graduate School of Medicine, Nagoya, Japan.
²² Keio University School of Medicine, Keio, Japan.
²³ University of Ottawa, Ottawa, Ontario, Canada.
²⁴ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
²⁵ Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

PMID: 29164029
PMCID: PMC5684839
DOI: 10.1177/2192568217701910

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.

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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.

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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. - PMC - PubMed
1. Shiffman RN, Michel G. Toward improved guideline quality: using the COGS statement with GEM. Stud Health Technol Inform. 2004;107:159–163. - PubMed
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. - PubMed
1. Balshem H, Helfand M, Schunemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64:401–406. - PubMed
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. - PubMed

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[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. - PMC - PubMed

[2] 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. - PMC - PubMed

[3] Shiffman RN, Michel G. Toward improved guideline quality: using the COGS statement with GEM. Stud Health Technol Inform. 2004;107:159–163. - PubMed

[4] Shiffman RN, Michel G. Toward improved guideline quality: using the COGS statement with GEM. Stud Health Technol Inform. 2004;107:159–163. - PubMed

[5] 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. - PubMed

[6] 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. - PubMed

[7] Balshem H, Helfand M, Schunemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64:401–406. - PubMed

[8] Balshem H, Helfand M, Schunemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64:401–406. - PubMed

[9] 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. - PubMed

[10] 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. - PubMed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

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