Scoping review of peer reviewed publications addressing rehabilitation for people sustaining traumatic spinal cord injury

Lynn H Gerber; Haley Bush; Xinsheng Cindy Cai; Leslie Morse; Lynn Worobey; Steven Garfinkel

doi:10.1080/10790268.2019.1645415

Scoping review of peer reviewed publications addressing rehabilitation for people sustaining traumatic spinal cord injury

J Spinal Cord Med. 2020 Jul;43(4):421-427. doi: 10.1080/10790268.2019.1645415. Epub 2019 Aug 12.

Authors

Lynn H Gerber^{1

2}, Haley Bush¹, Xinsheng Cindy Cai³, Leslie Morse⁴, Lynn Worobey⁵, Steven Garfinkel³

Affiliations

¹ Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.
² Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, Virginia, USA.
³ American Institute for Research, Washington, DC, USA.
⁴ Craig Center for Regenerative Research, University of Colorado, Englewood, Colorado, USA.
⁵ Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Abstract

Study Design: Scoping review Objective: To study the design, clinical setting and outcome measures used in spinal cord injury rehabilitation publications. Methods: A literature search on PubMed and Medline was conducted focusing on articles published between 1990-2016 and using "traumatic SCI", "functional outcomes", "rehabilitation", "work" and "return to work" as outcomes. Studies were categorized based on design (intervention, including RCTs vs. non-intervention studies), settings (inpatient vs. outpatient vs. transition), and outcome measures used (impairment vs. function vs. participation/integration vs. quality of life vs. symptoms). Work-related studies were categorized independently. Results: Five hundred forty-four articles met the inclusion criteria. Of these, 234 were interventional studies, including 23 RCTs. Studies were evenly divided among inpatient, outpatient and transition settings. Of the 234 interventional studies, 143 used functional evaluations. Sixty-one different functional instruments were used, with a predominant use of the Functional Independence Measure (61 times) and an additional use of SCI-specific measures, i.e. Spinal Cord Independence Measure and Craig Handicap Assessment and Reporting Technique (13 times each). Fifty-one studies measured mobility, while only three measured hand functions. The work-related sub-analysis revealed 32 intervention studies (no RCTs), of which 15 used functional evaluations and only three focused on tetraplegia. Conclusion: Our study revealed a paucity of intervention trials and RCTs, indicating a dearth of knowledge that would be needed to establish evidence-based practice guidelines. This is particularly true for tetraplegia. While standard measures of function were frequently used, providing valuable data, there is no consensus about what exact outcome measure to use. Using newer measurement techniques, for instance based on the application of item response theory, should be considered to enhance uniformity.

Keywords: Function; Rehabilitation; Scoping review; Spinal cord injury.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.
Review

MeSH terms

Humans
Inpatients
Neurological Rehabilitation*
Outcome Assessment, Health Care
Quality of Life
Spinal Cord Injuries*

Grants and funding

Funded through a subcontract to George Mason University from the American Institutes for Research, supported by Federal Grant (NIDILRR#90DP0012-01-00).