Developing a consensus on the core educational content to be acquired by people with spinal cord injuries during rehabilitation: findings from a Delphi study followed by a Consensus Conference.

STUDY DESIGN: Three-round Delphi study followed by a Consensus Conference with selected stakeholders. OBJECTIVES: To identify a set of core educational content that people with spinal cord injury (SCI) need to acquire during rehabilitation. SETTING: The Delphi study was performed electronically. The Consensus Conference was held at the Città della Salute e della Scienza University Hospital of Turin, Italy. METHODS: A panel of 20 experts (healthcare professionals and SCI survivors) participated in a three-round Delphi study. In round 1, arguments for core educational content were solicited and reduced into items. In rounds 2 and 3, a five-point Likert scale was used to find consensus on and validate core educational content items (threshold for consensus and agreement: 60% and 80%, respectively). A Consensus Conference involving 32 stakeholders was held to discuss, modify (if appropriate) and approve the list of validated items. RESULTS: The 171 arguments proposed in round 1 were reduced into 74 items; 67 were validated in round 3. The Consensus Conference approved a final list of 72 core educational content items, covering 16 categories, which were made into a checklist. CONCLUSIONS: Consensus was achieved for a set of core educational content for people with SCI. The resultant checklist could serve as an assessment tool for both healthcare professionals and SCI survivors. It can also be used to support SCI survivors' education, streamline resource use and bridge the gap between information provided during rehabilitation and information SCI survivors need to function in the community.

Barriers and facilitators of education provided during rehabilitation of people with spinal cord injuries: A qualitative description.

BACKGROUND: After a spinal cord injury (SCI), individuals must acquire their maximum level of independence before returning to their previous social and working conditions. The education provided during rehabilitation is one of the basic but complex aspects that influence the health perspectives of people with SCI. Gaining the perspective of SCI survivors experienced barriers and resources to enhance the education process may assist healthcare professionals in understanding this complex aspect of their practice. Through a qualitative descriptive analysis, this study aimed to identify the perceived barriers and facilitators of education provided during the rehabilitation of individuals with SCI. METHODS: A purposive sample of 22 adults with SCI and at least six months of home experience was recruited. Participants were assigned into four mini focus groups according to their level of independence. The focus groups were audio-recorded, transcribed verbatim, and analysed using a thematic analysis. RESULTS: Three themes were identified: the readiness to education, the individual characteristics, and the environmental and social characteristics influencing education. Participants perceived education to be an ongoing process made up of consecutive phases, each of which had to be overcome before participants felt ready to reappraise their health and well-being. This process was affected by individual, environmental, and social factors. CONCLUSIONS: Education is constantly provided by all members of the rehabilitation team. These must stress the relevance of the contents presented, increase SCI survivors' motivation to set achievable goals, and consider filling the gap that the patients perceive between rehabilitation centres and available community resources. The findings of this study promote the design of structured educational programmes, increasing knowledge, and improve the health perspective of SCI survivors, their families, and providers.

Possible role of dopamine D1-like and D2-like receptors in behavioural activation and "contingent" reward evaluation in sodium-replete and sodium-depleted rats licking for NaCl solutions.

Based on the different effects of the dopamine D1-like and D2-like receptor antagonists SCH 23390 and raclopride on the measures of licking microstructure in rats, we suggested that the level of activation of reward-associated responses depends on dopamine D1-like receptor stimulation, and is updated, or "reboosted", on the basis of a dopamine D2-like receptor-mediated reward evaluation. To further test this hypothesis, we examined the effects of the dopamine D2-like receptor antagonist raclopride (0, 25, 125, 250µg/kg) and of the dopamine D1-like receptor antagonist SCH 23390 (0, 10, 20 and 40µg/kg) on the microstructure of licking for two different NaCl solutions (0.9% and 2.7%) in rats in sodium-replete status and in the sodium-depleted status induced by the diuretic drug furosemide. Rats were exposed to each solution for 180 seconds after the first lick. Both in sodium-replete and in sodium-depleted status, SCH 23390 produced a decrease of burst number, a measure of behavioural activation, without affecting their size, a measure of reward evaluation. Raclopride reduced burst number but appeared also to exert some effects on burst size. Sodium depletion resulted in an increased intake for both NaCl solutions due to an increase in burst number and size, and in a reduced sensitivity to the effect of raclopride on lick number. These results are not in contrast with the proposed hypothesis and are consistent with previous evidence suggesting a role for dopamine D2-like receptors in the increased NaCl appetite induced by sodium depletion.