SCI Guidelines and Resource Development
ONF has funded several resources which inform best healthcare practices for people with SCI. These include websites and guidelines for treating a variety of secondary health complications, rehabilitation and community living.
ONF funded online resources
SCIRE - comprehensive website focusing on rehabilitation and community reintegration
The Spinal Cord Injury Rehabilitation Evidence (SCIRE) is a comprehensive website with a set of topics relevant to SCI rehabilitation and community reintegration. SCIRE reviews, evaluates, and translates existing research knowledge into a clear and concise format to inform health professionals and other stakeholders of best rehabilitation practices following SCI.
The SCIRE project is a Canadian research collaboration supported by ONF between scientists, clinicians and people with SCI in Vancouver, British Columbia and London, Ontario, as well as their respective health centres. For more information, visit the SCIRE website.
Spinal Cord Injury Knowledge Mobilization Network (SCI KMN)
Spinal Cord Injury Knowledge Mobilization Network (SCI KMN), initiated in January 2011, is a community of practice that includes seven rehabilitation hospitals across Canada. The goal of the network is to improve health outcomes for persons with spinal cord injury through what is known as implementation science or IS, which can lead to innovations in clinical practice. The SCI KMN has worked with the National Implementation Research Network (NIRN) to build expertise and capacity in Implementation Science across all seven facilities. For more information about this project, click here.
To date the pressure ulcer prevention practices (i.e. comprehensive risk assessment and treatment; patient education) have been fully implemented by six sites in rehab and by one site in acute care and an outpatient clinic. Five sites have reached initial implementation of the pain practices (comprehensive pain assessment and treatment; addressing patients' concerns and expectations)and another site is currently customizing the pain practices to their local context with the goal of implementing parts of the pain practice in 3-6 months.
Each of the sites have used the implementation skills/capacity developed through the SCI KMN and applied them to other initiatives at their site. Success of this approach to date has been much greater than initially anticipated, and demonstrates a culture of implementation and quality improvement that can be applied to a variety of initiatives. A significant contribution from SCI KMN was adapting the NIRN frameworks to support best practice implementation for spinal cord injury patients. By adapting and utilizing these frameworks the SCI KMN has identified key implementation processes that can help ensure future interventions and best practices can be successfully implemented across Canada. To learn more go to www.scikmn.com.
Relevant peer-reviewed publications:
Scovil CY, Flett HM, McMillan LT, Delparte JJ, Leber DJ, Brown J, Burns AS, and Spinal Cord Injury Knowledge Mobilization Network (SCI KMN). (2014). The application of implementation science for pressure ulcer prevention best practices in an inpatient spinal cord injury rehabilitation program. Journal of Spinal Cord Medicine, 37(5):589-597.
Duda MA, Riopelle R, Brown J, SCI KMN. (2014). From Theory to Practice: An Illustrative Case for Selecting Evidence-Based Practices and Building Implementation Capacity in Three Canadian Health Jurisdictions. Evidence and Policy, 10(4): 565-577.
Currently there are many individuals with SCI who do not have a family physician and some who do have one but are not satisfied with the services they receive. On the other hand, many family physicians either have never seen an SCI patient or have a few in their routine practice. This poses challenges for the physicians.
The Caring for Persons with Spinal Cord Injury is an e-learning resource, designed by ONF and the University of Ottawa, specifically for family physicians who are presently caring for, or are considering providing care for, peeople with SCI in their practice. To learn more about this project, click here.
To access the e-learning resource, go to Caring for Persons with Spinal Cord Injury.
ONF funded best practice guidelines
Canadian Best Practice Guidelines for Pressure Ulcers
Pressure sores are the most common secondary complication of SCI. ONF, in partnerships with the Rick Hansen Institute (RHI), has supported research to create standardized, evidence-based practices for the treatment of pressure sores.
Working with those with SCI, wound care and SCI experts, this partnership developed and published the “Canadian Clinical Best Practice Guidelines for the Prevention and Treatment of Pressure Ulcers”, which were released in 2011. The guidelines are current and applicable in the Canadian healthcare context.
To view these guidelines, please see SCI Pressure Ulcers Best Practice Guidelines (PDF 25.7 MB).
ONF supports RHI in taking the lead for implementing these best practices in Ontario, Quebec, Alberta, and ultimately across Canada.
Neuropathic Pain Best Practice Guideline
Chronic pain, is a common secondary health condition for people with SCI. Almost 40 percent of individuals with SCI have chronic and/or neuropathic pain. Recognizing the critical need for guidelines in this area, a team from Parkwood Hospital in London, Ontario have taken the lead to develop the guideline for management of neuropathic pain.
This best practice guideline will assist in standardization of care and appropriate management of pain for individuals with SCI. Pain management is important to improve psychosocial, as well as physical health and overall quality of life for people with SCI.
The CanPainSCI Rehabilitation Clinical Practice Guideline for Management of Neuropathic Pain after Spinal Cord Injury is available here.
Physical Activity Guidelines and Guide
ONF supported the development of physical activity guidelines for individuals with SCI by a team of researchers at McMaster University.
These guidelines recommend the ideal amount of exercise individuals with SCI should do to live active, healthy and independent lives. They suggest that to improve fitness, healthy adults with SCI should participate in at least 20 minutes of moderate to vigorous aerobic activity twice per week, as well as strength training exercises twice per week.
Along with the guidelines, there is a SCI GET FIT toolkit which is a Canadian resource to help adults with spinal cord injury meet physical activity guidelines. They have also developed a two-page guide to support individuals in setting up and maintaining their physical activity program. The group has made guidelines and other related resources available on their website SCI Action Canada.
Acute SCI Guidelines Development
Led by Dr. Michael Fehlings and supported by AOSPINE, ONF is participating in five acute spinal cord injury management guidelines under development -- Magnetic Resonance Imaging; early versus late surgical decompression; use of Methyl Prednisolone; Anticoagulation; and Rehabilitation timing and duration. The guidelines are projected to be completed in 2016. There are number of articles under development for publication on the different guidelines including the process of developing practice guidelines.
The Spinal Cord Injury Rehabilitation Care High Performance Indicators (SCI -HIGH) Project was started in 2015 to establish a core set of indicators that represent optimal rehabilitation care. The goal of this project is to facilitate uniform measurement and benchmarking of high quality care among individuals with SCI in the first 18 months after inpatient rehabilitation admission. The 11 rehabilitation care domains to target while developing rehab care indicators are Urinary Tract Infection (UTI) Prevention, Community Participation & Employment, Wheeled Mobility, Bladder Health, Skin Integrity, Informed Self-Management, Cardiovascular Integrity, Emotional Wellbeing, Walking, Reaching, Grasping & Manipulation, and Sexual Health. More information about the project is available here.