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 & 13 others 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

Research output: Contribution to journalArticle

6 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)231S-238S
JournalGlobal Spine Journal
Volume7
Issue number3_supplement
DOIs
Publication statusPublished - 2017 Sep 1

Fingerprint

Practice Management
Spinal Cord Injuries
Practice Guidelines
Rehabilitation
Guidelines
Walking
Expert Testimony
Upper Extremity
Electric Stimulation
Hand
Morbidity

Keywords

  • acute spinal cord injury
  • clinical guideline
  • guideline
  • rehabilitation
  • spinal cord injury
  • traumatic spinal cord injury

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Fehlings, M. G., Tetreault, L. A., Aarabi, B., Anderson, P., Arnold, P. M., Brodke, D. S., ... Burns, A. S. (2017). A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Rehabilitation. Global Spine Journal, 7(3_supplement), 231S-238S. https://doi.org/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. / Fehlings, Michael G.; Tetreault, Lindsay A.; Aarabi, Bizhan; Anderson, Paul; Arnold, Paul M.; Brodke, Darrel S.; Chiba, Kazuhiro; Dettori, Joseph R.; Furlan, Julio C.; Harrop, James S.; Hawryluk, Gregory; Holly, Langston T.; Howley, Susan; Jeji, Tara; Kalsi-Ryan, Sukhvinder; Kotter, Mark; Kurpad, Shekar; Kwon, Brian K.; Marino, Ralph J.; Martin, Allan R.; Massicotte, Eric; Merli, Geno; Middleton, James W.; Nakashima, Hiroaki; Nagoshi, Narihito; Palmieri, Katherine; Singh, Anoushka; Skelly, Andrea C.; Tsai, Eve C.; Vaccaro, Alexander; Wilson, Jefferson R.; Yee, Albert; Burns, Anthony S.

In: Global Spine Journal, Vol. 7, No. 3_supplement, 01.09.2017, p. 231S-238S.

Research output: Contribution to journalArticle

Fehlings, MG, Tetreault, LA, Aarabi, B, Anderson, P, Arnold, PM, Brodke, DS, Chiba, K, Dettori, JR, Furlan, JC, Harrop, JS, Hawryluk, G, Holly, LT, Howley, S, Jeji, T, Kalsi-Ryan, S, Kotter, M, Kurpad, S, Kwon, BK, Marino, RJ, Martin, AR, Massicotte, E, Merli, G, Middleton, JW, Nakashima, H, Nagoshi, N, Palmieri, K, Singh, A, Skelly, AC, Tsai, EC, Vaccaro, A, Wilson, JR, Yee, A & Burns, AS 2017, 'A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Rehabilitation', Global Spine Journal, vol. 7, no. 3_supplement, pp. 231S-238S. https://doi.org/10.1177/2192568217701910
Fehlings, Michael G. ; Tetreault, Lindsay A. ; Aarabi, Bizhan ; Anderson, Paul ; Arnold, Paul M. ; Brodke, Darrel S. ; Chiba, Kazuhiro ; Dettori, Joseph R. ; Furlan, Julio C. ; Harrop, James S. ; Hawryluk, Gregory ; Holly, Langston T. ; Howley, Susan ; Jeji, Tara ; Kalsi-Ryan, Sukhvinder ; Kotter, Mark ; Kurpad, Shekar ; Kwon, Brian K. ; Marino, Ralph J. ; Martin, Allan R. ; Massicotte, Eric ; Merli, Geno ; Middleton, James W. ; Nakashima, Hiroaki ; Nagoshi, Narihito ; Palmieri, Katherine ; Singh, Anoushka ; Skelly, Andrea C. ; Tsai, Eve C. ; Vaccaro, Alexander ; Wilson, Jefferson R. ; Yee, Albert ; Burns, Anthony S. / A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury : Recommendations on the Type and Timing of Rehabilitation. In: Global Spine Journal. 2017 ; Vol. 7, No. 3_supplement. pp. 231S-238S.
@article{4ef0e5380b684e15ba48310666029378,
title = "A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Rehabilitation",
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",
author = "Fehlings, {Michael G.} and Tetreault, {Lindsay A.} and Bizhan Aarabi and Paul Anderson and Arnold, {Paul M.} and Brodke, {Darrel S.} and Kazuhiro Chiba and Dettori, {Joseph R.} and Furlan, {Julio C.} and Harrop, {James S.} and Gregory Hawryluk and Holly, {Langston T.} and Susan Howley and Tara Jeji and Sukhvinder Kalsi-Ryan and Mark Kotter and Shekar Kurpad and Kwon, {Brian K.} and Marino, {Ralph J.} and Martin, {Allan R.} and Eric Massicotte and Geno Merli and Middleton, {James W.} and Hiroaki Nakashima and Narihito Nagoshi and Katherine Palmieri and Anoushka Singh and Skelly, {Andrea C.} and Tsai, {Eve C.} and Alexander Vaccaro and Wilson, {Jefferson R.} and Albert Yee and Burns, {Anthony S.}",
year = "2017",
month = "9",
day = "1",
doi = "10.1177/2192568217701910",
language = "English",
volume = "7",
pages = "231S--238S",
journal = "Global Spine Journal",
issn = "2192-5682",
publisher = "Thieme Medical Publishers",
number = "3_supplement",

}

TY - JOUR

T1 - A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury

T2 - Recommendations on the Type and Timing of Rehabilitation

AU - Fehlings, Michael G.

AU - Tetreault, Lindsay A.

AU - Aarabi, Bizhan

AU - Anderson, Paul

AU - Arnold, Paul M.

AU - Brodke, Darrel S.

AU - Chiba, Kazuhiro

AU - Dettori, Joseph R.

AU - Furlan, Julio C.

AU - Harrop, James S.

AU - Hawryluk, Gregory

AU - Holly, Langston T.

AU - Howley, Susan

AU - Jeji, Tara

AU - Kalsi-Ryan, Sukhvinder

AU - Kotter, Mark

AU - Kurpad, Shekar

AU - Kwon, Brian K.

AU - Marino, Ralph J.

AU - Martin, Allan R.

AU - Massicotte, Eric

AU - Merli, Geno

AU - Middleton, James W.

AU - Nakashima, Hiroaki

AU - Nagoshi, Narihito

AU - Palmieri, Katherine

AU - Singh, Anoushka

AU - Skelly, Andrea C.

AU - Tsai, Eve C.

AU - Vaccaro, Alexander

AU - Wilson, Jefferson R.

AU - Yee, Albert

AU - Burns, Anthony S.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - 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.

AB - 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.

KW - acute spinal cord injury

KW - clinical guideline

KW - guideline

KW - rehabilitation

KW - spinal cord injury

KW - traumatic spinal cord injury

UR - http://www.scopus.com/inward/record.url?scp=85029120901&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85029120901&partnerID=8YFLogxK

U2 - 10.1177/2192568217701910

DO - 10.1177/2192568217701910

M3 - Article

VL - 7

SP - 231S-238S

JO - Global Spine Journal

JF - Global Spine Journal

SN - 2192-5682

IS - 3_supplement

ER -