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» Impact of the Clinical Practice Guideline for Preservation of Upper Limb Function on Transfer Skills of Persons with Acute Spinal Cord Injury

Impact of the Clinical Practice Guideline for Preservation of Upper Limb Function on Transfer Skills of Persons with Acute Spinal Cord Injury

Objectives: To describe the development of a strict education protocol to implement the clinical practice guideline “Preservation of Upper Limb Function Following Spinal Cord Injury” into a clinical setting and evaluate the effect of the protocol on transfer quality.
Design: Randomized Clinical Trial
Setting: Acute Model Spinal Cord Injury Systems Rehabilitation Facility and community
Participants: Volunteer sample of 70 full time wheelchair users with new spinal cord injuries randomized (1:1) to an intervention and standard of care group.
Main Outcome Measures: Comparison of transfer quality evaluated by the Transfer Assessment Instrument at four time points during first year after injury.
Intervention: The intervention group was educated on transfer skills with a structured protocol implemented by a Physical and Occupational therapist who were extensively educated on the clinical practice guidelines and current transfer research. The standard of care group received standard therapy services.
Results: No significant differences were found between study groups. Secondary analysis based on type of transfer performed found that participants in the intervention group who performed assisted sitting pivot transfers performed higher quality transfers (M = 9.43, SE = 0.55) compared to the standard of care group (M = 7.81, SE = 0.46), p = 0.026 at one year after discharge. Also, participants who performed a dependent transfer had a higher average score across all four time points (M = 9.14, SE = 0.34) compared to the standard of care group (M = 8.09, SE =0.29), p = 0.019.
Conclusion: For participants who perform assisted or dependent transfers, use of an evidenced based, structured education program during acute inpatient rehabilitation has potential to significantly improve the quality of transfers. Further follow up testing is necessary with a larger sample size to determine the long term effects.

Laura A. Rice, PhD, MPT, ATP; Ian Smith, MS; Annmaire R. Kelleher, MS,OTR/L, ATP, CCRC; Karen Greenwald, RN, BSN; Claire Hoelmer; Michael L. Boninger, MD. Arch Phys Med Rehabil, 2013. 94(7): p. 1230-46.