B. Boggenpoel1, A. Rhoda1, N. Kruger2, C. Joseph3
1University of the Western Cape, Physiotherapy, Cape Town, South Africa, 2Groote Schuur Hospital, University of Cape Town, Department of Orthopaedics, Cape Town, South Africa, 3Stellenbosch University, Health and Rehabilitation Sciences, Cape Town, South Africa
Background: Prioritising clinical research is important so that one can ensure that it has a meaningful impact on patient outcomes, and is of value to the patient. Currently, there is no literature that identifies clinical research questions that would facilitate traumatic spinal cord injury (tSCI) management for the South African context.
Purpose: To identify key research questions to facilitate tSCI management in the South African context.
Methods: A Delphi consensus method was used to identify a list of key clinical research questions that should be investigated to improve the overall management of persons who have sustained a tSCI. Panelists who were invited to participate in this study included spinal cord injury physician consultants / orthopaedic surgeons and neurologists working in the acute and post-acute phase of tSCI management. They also included experts such as professional nurses, radiologists, physiotherapists and paramedics, who are involved in the provision of care along the injury pathway. Formal consensus (i.e., set at 70%) regarding these research questions were reached after two online surveys.
Results: Six of the eleven (55%) participants who accepted the Pre-Delphi invitations completed the first Delphi iteration. There was a 100% (6/6) response rate in the second round. The key clinical questions raised by participants were grouped according to structure and process elements of management:
Questionsrelated to structural elements of management:
(1) What are the levels of expertise and training of nursing and medical staff in recognising SCI complications early and instituting appropriate effective long term treatment regimes in our resource poor environment?
(2) What is the level of training of undergraduates in various medical schools with respect to closed reduction in cervical spine dislocations?
(3) What is the knowledge and training of emergency room (ER) doctors in X-ray interpretation and diagnosis of various cervical conditions?
(4) What is the knowledge of ER doctors around South Africa regarding management of cervical spine dislocations and closed cervical dislocations?
(5) What is the level of equipment readiness in various hospitals around South Africa regarding cervical reduction , calipers, weights and pulleys and availability of X-rays?
(6) What are the most beneficial acute care rehabilitation pathways?
(7) What is the minimum training required for South African paramedics?
Questions related to process elements of management:
(1) What are the minimum guidelines necessary to ensure medical and neurological stability after SCI in rural settings?
(2) Who should be doing spinal clearance and can it be done effectively by lower-level providers?
(3) How do different provincial SCI protocols and resources compare and how do they effectively serve a growing population?
Questionsrelated to structural elements of management:
(1) What are the levels of expertise and training of nursing and medical staff in recognising SCI complications early and instituting appropriate effective long term treatment regimes in our resource poor environment?
(2) What is the level of training of undergraduates in various medical schools with respect to closed reduction in cervical spine dislocations?
(3) What is the knowledge and training of emergency room (ER) doctors in X-ray interpretation and diagnosis of various cervical conditions?
(4) What is the knowledge of ER doctors around South Africa regarding management of cervical spine dislocations and closed cervical dislocations?
(5) What is the level of equipment readiness in various hospitals around South Africa regarding cervical reduction , calipers, weights and pulleys and availability of X-rays?
(6) What are the most beneficial acute care rehabilitation pathways?
(7) What is the minimum training required for South African paramedics?
Questions related to process elements of management:
(1) What are the minimum guidelines necessary to ensure medical and neurological stability after SCI in rural settings?
(2) Who should be doing spinal clearance and can it be done effectively by lower-level providers?
(3) How do different provincial SCI protocols and resources compare and how do they effectively serve a growing population?
Conclusions: The clinical research questions identified allows for meaningful research to be conducted, which will have a direct impact on current care processes within the management of persons with tSCI.
Implications: These questions will serve as a starting point to contribute to the development of a set of contextually relevant guidelines for tSCI management in South Africa which can improve the prognosis of outcomes related to function and mortality.
Funding acknowledgements: This study received no funding
Keywords:
traumatic spinal cord injury
research priorities
South Africa
traumatic spinal cord injury
research priorities
South Africa
Topics:
Neurology: spinal cord injury
Disability & rehabilitation
Neurology: spinal cord injury
Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: University of the Western Cape
Committee: Biomedical Research Ethics Committee (BMREC)
Ethics number: BM18/8/16
All authors, affiliations and abstracts have been published as submitted.
