Who wants to walk? Preferences for recovery after SCI: a longitudinal and cross-sectional study

Abstract

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.

Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale

“…1 Far from being unrealistic, statistics show that up to one-third of all people with a new SCI will recover some walking ability at 1 year post injury. 2 The initial presence of motor function is especially relevant to infer on the future ambulatory status.…”

Who wants to walk? Preferences for recovery after SCI: a longitudinal and cross-sectional study

“…Despite raised questions, we praise the efforts that have been made by Ditunno et al 1 This study stresses the importance of implementing patient-related recovery priorities in the development of future rehabilitation programs. In future research programs, however, the use of appropriately defined outcome measures with adequate face validity is mandatory.…”

“…The body has been 'privatized' in our social life. 3,4 This could also be the reason why toilet transfers score relatively high within the functional entity transfers, see Figures 2 and 3 in Ditunno et al 1 This significant socially uncomfortable issue stresses the importance of emotional affection in choosing preferences for recovery. However, as the bowel care is indirectly a part of functional entity transfers, this in turn might act as a confounder within this entity.…”

“…We have read with great interest the descriptive study by Ditunno et al 1 evaluating preferences for recovery in SCI patients. Using a modified version of the features-resources trade-off game and a modified version of the functional independence measure, this challenging study evaluated the preference of patients with spinal cord injury (SCI) for the restoration of walking.…”

“…Schönherr et al 5 reported that the correct predictions were most often found regarding the mobility of patients with complete lesions. Ditunno et al, 1 however, report a stage 4 preference for independent walking with device in patients with complete SCI. This stresses the importance of patient education in the (sub)acute care setting.…”