AUSTRALIAN AND NEW ZEALAND CLINICAL PRACTICE GUIDELINES FOR THE PHYSIOTHERAPY MANAGEMENT OF PEOPLE WITH SPINAL CORD INJURIES

J.V. Glinsky¹, K. Tranter¹, L. Harvey¹, Australian and New Zealand Clinical Practice Guidelines Consortium

¹John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and The University of Sydney, Kolling Institute, Sydney, Australia

Background: Clinical Guidelines about the physiotherapy management of people with Spinal Cord (SCI) are essential for physiotherapists, people with SCI and their caregivers. High quality Clinical Guidelines provide succinct and credible recommendations to guide practice.

Purpose: To provide evidence-based recommendations and consensus-based opinion statements about the physiotherapy treatment of adults with SCI.

Methods: Systematic reviews of randomised controlled trials of physiotherapy interventions for adults with SCI were conducted on guideline questions. Questions were pre-determined, approved by a guideline panel and presented in PICO format (namely, Participant, Intervention, Comparison and Outcome). Meta-analyses were conducted across trials that made similar comparisons if there were at least two studies without excessive clinical or statistical heterogeneity. A Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to develop recommendations and to assess the certainty of the evidence. A Guideline Development panel made evidence recommendations and consensus-based opinion statements for each outcome based on a standardised process that included voting. Evidence recommendations were made for or against an intervention and defined as strong or weak by the guideline panel. Where possible each PICO was rated for certainty according to the GRADE approach where evidence was defined as very low, low, moderate, or high certainty. No evidence recommendation was made if no randomised controlled trials were identified or if the available randomised controlled trial/s provided insufficient or inconclusive evidence. Where evidence recommendations could not be made, strong or weak consensus-based opinion statements for or against an intervention were voted on by the Guideline Development Panel. Clinical notes based on the expert opinion of the panel were written to accompany evidence recommendations and consensus-based opinion statements where required.

Results: Seventy-six randomised controlled trials met the inclusion criteria of the systematic reviews and informed 20 meta-analyses that were used in the guidelines. Over 100 evidence recommendations and consensus-based opinion statements about the physiotherapy treatment of people with SCI were determined by the guidelines panel. These recommendations and statements were across 13 categories of interventions including respiratory management, pain management, strength training, skill training, and cardiorespiratory fitness training. All evidence was rated as low certainty according to the GRADE approach.

Conclusions: The Australian and New Zealand Clinical Practice Guidelines are now available to guide the physiotherapy treatment of people with SCI. These guidelines are based on the best available evidence but limited by the paucity of high-quality clinical trials.

Implications: Clinical Practice guidelines provide physiotherapists with guidance on the physiotherapy management of adults with SCI across the continuum of care. They also provide invaluable information for people with SCI and care givers to make treatment decisions based on recommendations and statements from a representative guidelines panel.

Funding acknowledgements: Funded from icare NSW, National Injury Insurance Scheme Queensland, Transport Accident Commission Victoria, and Lifetime Support Authority South Australia.

Keywords:
Spinal Cord Injury
Clinical Practice Guidelines
Evidence based practice

Topics:
Neurology: spinal cord injury
Disability & rehabilitation
Neurology

Did this work require ethics approval? No

Reason: Not applicable. Ethical approval is not required for systematic reviews and clinical guidelines