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Review
. 2024 Sep 9:5:1371556.
doi: 10.3389/fresc.2024.1371556. eCollection 2024.

Evidence based clinical practice guideline for follow-up care in persons with spinal cord injury

Inge Eriks-Hoogland  1   2   3 , Lorena Müller  3 , Michael Baumberger  1 , Burkhart Huber  4 , Franz Michel  5 , Celina Belfrage  1 , Hicham Elmerghini  1 , Mide Veseli-Abazi  1 , Ralf Böthig  6 , Kai Fiebag  6 , Roland Thietje  6 , Xavier Jordan  7
Affiliations
Review

Evidence based clinical practice guideline for follow-up care in persons with spinal cord injury

Inge Eriks-Hoogland et al. Front Rehabil Sci. .

Abstract

Introduction: While it is well-established that follow-up care programs play a crucial role in preventing and early detecting secondary health conditions (SHCs) in persons with spinal cord injury [SCI, including spina bifida (SB)], the availability of evidence-based follow-up care programs remains limited. Under the leadership of the German-speaking Medical Society for Paraplegiology (DMGP), we have developed an evidence based clinical practice guideline for follow-up care of SHCs in persons with SCI and identify research gaps.

Methods: This guideline was developed in accordance with the regulations of the Association of the Scientific Medical Societies in Germany (AWMF e.V.). To ensure an evidence-based guidance, we utilized the International Classification of Functioning, Disability and Health (ICF) generic core set and ICF Core Set for individuals with SCI in long-term context as our foundational framework. We conducted a comprehensive literature review to identify existing recommendations for follow-up care and graded the level of evidence according to relevant instruments. Subsequently, we formulated recommendations and achieved consensus through a structured nominal group process involving defined steps and neutral moderation, while adhering to the criteria outlined in the German guideline development instrument (DELBI).

Results: Although there is a fair number of literatures describing prevalence and severity of SHCs after SCI, the amount of literature including recommendations was low (19 for SCI and 6 for SB). Based on the current evidence on prevalence and severity of SHCs and available recommendations, a clinical practice guideline on follow-up care of most relevant SHCs was defined. The recommendations for follow-up care are described in the following chapters: (1) Nervous system; (2) (Neuropathic) pain; (3) Cardiovascular diseases; (4) Respiratory System; (5) Immunological system, vaccination and allergies; (6) Gastrointestinal tract and function; (7) Endocrinological system and nutrition; (8) Urogenital system; (9) Contraception, pregnancy, birth and postpartum care; (10) Musculoskeletal system; (11) Pressure injuries; (12) Psychological health; (13) Medication and polypharmacy.

Conclusion: We could successfully establish an evidence based clinical practice guideline for follow-up care of SHCs in individuals with SCI. There is however a notable lack of high-quality recommendations for SCI follow-up care.

Keywords: guideline; lifelong follow-up care; outpatient care; prevention; spina bifida; spinal cord disease; spinal cord injury.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Guideline development process.
Figure 2
Figure 2
Process systematic literature review, quality assessment, grading of evidence and grade of recommendation.
See this image and copyright information in PMC

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