Study design: Cross-sectional and longitudinal direct observation of a constrained consensus-building process in nine consumer panels and three rehabilitation professional panels. Objectives: To illustrate differences among consumer and clinician preferences for the restoration of walking function based on severity of injury, time of injury and age of the individual. Setting: Regional Spinal Cord Center in Philadelphia, USA. Methods: Twelve panels (consumer and clinical) came to independent consensus using the featuresresource trade-off game. The procedure involves trading imagined levels of independence (resources) across different functional items (features) at different stages of recovery. Results: Walking is given priority early in the game by eight out of nine consumer panels and by two out of three professional panels. The exception consumer panel (ISCIo50) moved walking later in the game, whereas the exception professional panel (rehRx) moved wheelchair early but walking much delayed. Bowel and Bladder was given primary importance in all panels. Conclusions: Walking is a high priority for recovery among consumers with spinal cord injury irrespective of severity of injury, time of injury and age at time of injury. Among professional staff, walking is also of high priority except in rehabilitation professionals.

Study design: Direct observation of a constrained consensus-building process in three culturally independent five-person panels of rehabilitation professionals from the US, Italy and Canada. Objectives: To illustrate cultural differences in belief among rehabilitation professionals about the relative importance of alternative functional goals during spinal cord injury (SCI) rehabilitation. Setting: Spinal Cord Injury Units in Philadelphia-USA, Rome-Italy and Vancouver-Canada. Methods: Each of the three panels came to independent consensus about recovery priorities in SCI utilizing the features resource trade-off game. The procedure involves trading imagined levels of independence (resources) across different functional items (features) assuming different stages of recovery. Results: Sphincter management was of primary importance to all three groups. The Italian and Canadian rehabilitation professionals, however, showed preference for walking over wheelchair mobility at lower stages of assumed recovery, whereas the US professionals set wheelchair independence at a higher priority than walking. Conclusions: These preliminary results suggest cross-cultural recovery priority differences among SCI rehabilitation professionals. These dissimilarities in preference may reflect disparities in values, cultural expectations and health care policies.

Objectives: To present a function-based strategy for classifying patients by expected functional outcomes measured as patients' performances at discharge on each of the 18 component items of the FIM 2 instrument (previously known as the Functional Independence Measure). Methods: Data included records from 3604 inpatients with traumatic spinal cord injury discharged from 358 rehabilitation units or hospitals in 1995. The function-based strategy assigned patients to four Discharge Motor-FIM-Function Related Groups de®ned by patients' admission performance on the motor-FIM items. Results: The majority of patients whose motor-FIM scores at admission were above 30 were able to groom, dress the upper body, manage bladder function, use a wheelchair, and transfer from bed to chair, either independently or with supervision, by the time of discharge from inpatient rehabilitation. Most patients whose scores were above 52 attained independence in all but the most di cult FIM tasks, such as bathing, tub transfers, and stair climbing. Conclusions: This classi®cation scheme can be used to determine the degree to which patients' actual FIM outcomes compare to other individuals who had similar levels of disabilities at the time of admission to rehabilitation. The clinician can apply these`FIM item attainment benchmarks' retrospectively in quality improvement, in guideline development, and in anticipating the types of post-discharge care required by clinically similar groups.

Objective: To determine the incidence of and risk factors for dose-limiting chemotherapy induced peripheral neuropathy (CIPN) in non-metastatic breast cancer. Methods: This retrospective cohort study included 488 women with an adjuvant or neoadjuvant treatment plan with docetaxel or paclitaxel from June 1, 2009 to December 31, 2011. Exclusion criteria were: metastatic disease, previous neurotoxic chemotherapy, pre-existing neuropathy, pregnant or within 3 months post-partum, and prosthetic limb. The primary outcome was dose-limiting CIPN, defined as a treatment modification event (dose delay, dose reduction, or treatment discontinuation) attributed to CIPN. The primary risk factor of interest was obesity (BMI≥30). Covariates included race, age, menopausal status, diabetes, and other comorbidities, node status, tumor size, regimen, and oncologist. With 80% power and 0.05 type I error rate, the study could detect a risk ratio of 1.8 in the obese versus non-obese. Results: Fifty (10.2%) women had a treatment modification event attributed to CIPN (TM-CIPN). TM-CIPN incidence differed significantly by agent (docetaxel = 2.4% (N = 5/209), paclitaxel=16.1% (N = 45/279); p < 0.001). In analyses restricted to patients treated with paclitaxel with complete covariate data (N = 273), the odds of TM-CIPN did not differ by obesity, OR = 1.17 (95% CI 0.59–2.35). After adjusting for black race, menopausal status, disease severity, and type II diabetes the TM-CIPN and obesity association was attenuated. The attenuation occurred after adjustment for black race, which was a confounder of the obesity and TM-CIPN relationship, and associated with obesity (OR = 3.78, p = <0.001). Post-menopausal status, disease severity, and type II diabetes were associated with obesity, but were not confounders. Compared to whites, and after controlling for disease severity, menopausal status, and oncologist, blacks and other non-whites had significantly increased odds of CIPN-TM (OR = 2.5, p < 0.02; OR = 4.8, p < 0.01; respectively). Tests of homogeneity indicated the race and TM-CIPN association was not modified by oncologist or disease severity. Conclusion: Obese and non-obese women have a comparable likelihood of having their treatment modified due to CIPN. Women of racial minorities had over 2-to 4-fold increased odds of TM-CIPN compared to white women. Investigations addressing the mechanistic explanations for this association are warranted. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-13-01.

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