Are Clinical Prediction Rules Used in Spinal Cord Injury Care? A Survey of Practice

Abstract

Background: Accurate outcome prediction is desirable post spinal cord injury (SCI), reducing uncertainty for patients and supporting personalized treatments. Numerous attempts have been made to create clinical prediction rules that identify patients who are likely to recover function. It is unknown to what extent these rules are routinely used in clinical practice.

Objectives: To better understand knowledge of, and attitudes toward, clinical prediction rules amongst SCI clinicians in the United Kingdom.

Methods: An online survey was distributed via mailing lists of clinical special interest groups and relevant National Health Service Trusts. Respondents answered questions about their knowledge of existing clinical prediction rules and their general attitudes to using them. They also provided information about their level of experience with SCI patients.

Results: One hundred SCI clinicians completed the survey. The majority (71%) were unaware of clinical prediction rules for SCI; only 8% reported using them in clinical practice. Less experienced clinicians were less likely to be aware. Lack of familiarity with prediction rules was reported as being a barrier to their use. The importance of clinical expertise when making prognostic decisions was emphasized. All respondents reported interest in using clinical prediction rules in the future.

Conclusion: The results show widespread lack of awareness of clinical prediction rules amongst SCI clinicians in the United Kingdom. However, clinicians were positive about the potential for clinical prediction rules to support decision-making. More focus should be directed toward refining current rules and improving dissemination within the SCI community.

Keywords: clinical decision rules; physical functional performance; prognosis; rehabilitation; spinal cord injuries.

Figure 1.

Level of agreement with different statements about clinical prediction rules (CPR).

Figure 2.

Awareness of clinical prediction rules (CPR). Left subplot shows proportion of respondents (100 total) who were either aware or unaware of CPR for spinal cord injury (SCI). Subplot on right side shows number of people aware of each named CPR (out of 29 total respondents). Respondents could select multiple options, hence numbers total more than 29. Named CPR: Van Middendorp et al., 2011, Hicks et al., 2017, Jean et al., 2021, Hori et al., 2022.

Figure 3.

Ratings of accuracy for various prognostic indicators of function in spinal cord injury (SCI). Respondents only rated predictors that they reported using. Total number of responses for each predictor indicates how many respondents reported using it. AD = autonomic dysreflexia; AIS = ASIA Impairment Scale; FIM = Functional Independence Measure; SCIM = spinal cord independence measure; UTI = urinary tract infection.

Figure 4.

Boxplots comparing years of experience between respondents who were aware vs unaware of existing clinical prediction rules. Red lines indicate median values; boxes represent interquartile range (IQR); whiskers extend to 1.5 x IQR; circles denote outliers. Asterisk indicates a significant difference (p = .022).