Implementation of Guidelines for Prevention of Upper Limb Pain in Spinal Cord Injury: A Randomized Trial

Project Type
Independent
Principal Investigator Name
Michael Boninger MD
Principal Investigator Email
Start Date:
10/1/2006
End Date:
9/30/2011
Participating Centers:
Target Population(s):
New non-progressive SCI with residual neurologic deficit requiring wheelchair use for the majority of mobility (over 40 hours per week),
Project Website:
Abstract:
The preservation of upper limb function is an important aspect of care that clinicians must remember when instructing individuals affected by SCI on transfers skills, manual wheelchair propulsion and when selecting and setting up a wheelchair. An individual’s ability to perform transfers and propel a wheelchair is impacted by upper limb dysfunction. Due to high forces required to propel a wheelchair and perform transfers, the upper limb is often injured. In response to the impact of upper limb dysfunction on individuals with SCI, the clinical practice guideline (CPG): Preservation of Upper Limb Function Following SCI was developed by the Paralyzed Veterans of America. The CPG provides guidelines to clinicians on ways to preserve upper limb function in individuals with SCI. The guidelines provide recommendations on how to perform transfers, wheelchair propulsion and other activities of daily living in a manner that will not cause pain or deterioration of the upper limb. Unfortunately, research has found that clinician adherence to any type of CPG is low without additional education. The purpose of this study is to conduct a clinical trial to determine if strict and structured education on the CPG can change clinician behavior and the amount of information a patient learns and retains. An interventional group of study participants will be strictly educated on the CPG and a control group of subject will have standard physical and occupational therapy treatments. Both groups of patients will be evaluated on a series of items to determine if their transfers, wheelchair propulsion skills and wheelchair selection more closely match those recommendations set-forth by the CPG and if pain levels decrease and satisfaction with life increases compared to individuals who have had the standard of care.