The influence of psychological need on rehabilitation outcomes for people with spinal cord injury.

STUDY DESIGN: Single-centre, retrospective study of people with a spinal cord injury or disorder (PwSCI/D) and identified psychological need. OBJECTIVES: To examine the effect of psychological need on rehabilitation outcomes. SETTING: National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, United Kingdom. METHODS: Self-reported data from the Stoke Mandeville Spinal Needs Assessment Checklist (SMS-NAC) were used to examine identified psychological need (characterised by referral for psychological treatment, or scoring above clinical threshold in admission psychometric measures) on SCI rehabilitation outcome domains. Participants were grouped according to whether they were referred, not referred, scored above or below clinical threshold. RESULTS: 234 participants were included (Mean age at injury (years) = 53, 70% Male, 29% tetraplegia, 38% paraplegia, 33% ASIA D). There was a significant improvement in outcome scores from admission to discharge across all domains irrespective of participant group, however individuals with identified psychological need scored lower across all rehabilitation domains than those without. While individuals with psychological need demonstrated longer rehabilitation stays, more frequent and longer discharge delays, they also showed comparatively greater rehabilitation improvements. Psychological screening measures were more effective at detecting psychological need than individuals identified via referral, and participants scoring above clinical threshold had poorest overall rehabilitation outcomes. CONCLUSIONS: Individuals with psychological need have greater rehabilitation need and may require longer rehabilitation and benefit from additional discharge planning. Early, proactive psychometric screening can better facilitate improvements for delivering rehabilitation. Future research should consider specific contributing factors to psychological need, such as pre-existing mental health conditions or socio-demographic influences.

The value of the whole picture: rehabilitation outcome measurement using patient self-report and clinician-based assessments after spinal cord injury.

STUDY DESIGN: This is a retrospective longitudinal study. OBJECTIVES: To explore the relative impact and contribution of using both the Spinal Cord Independence Measure III (SCIM) and Stoke Mandeville Spinal Needs Assessment Checklist (SMS-NAC) to assess rehabilitation outcome following an acute spinal cord injury (SCI). SETTING: The study was performed at National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK. METHODS: A patient self-report SMS-NAC and clinician-rated SCIM were administered on admission and discharge from the NSIC as part of standardised care. This paper presents a retrospective analysis of the rehabilitation outcomes of 195 people with spinal cord injury (PwSCI) following their first admission. RESULTS: In both measures, PwSCI improved from admission to discharge. Individuals with higher SCI obtained lower scores in both measures, at both admission and discharge. The SMS-NAC demonstrated the greatest increase in knowledge and skill for PwSCI who had higher and more complete injuries. On the SCIM, PwSCI who had lower and less complete injuries demonstrated the greatest increase in outcome. CONCLUSIONS: Overall, both measures demonstrated responsiveness to change during SCI rehabilitation and enable clinicians to systematically determine areas to focus rehabilitation effort. The relative strengths and contribution to delivering person-centred care for each are identified. The SMS-NAC enables clinicians to record, for people with higher injuries, their subjective self-report of skill and knowledge gains from rehabilitation that may be missed with other measures. Consequently, using both is encouraged in appreciation of the value of recording verbal (instructional) independence as well as functional (physical) independence.

The creation and development of the dental practice-based research network.

BACKGROUND: Practice-based research networks (PBRNs) are consortia of practices committed to improving clinical practice. They have become more common and include dental PBRNs. Few reports in the literature, however, have addressed the structure and function of dental PBRNs. METHODS: After initial development in Alabama, the Dental Practice-Based Research Network (DPBRN) now includes practitioner-investigators in seven U.S. states and three Scandinavian countries. Although most of the function and structure was developed at the inception of DPBRN, valuable input from practitioner-investigators has led to significant ongoing refinements. RESULTS: DPBRN practitioner-investigators have contributed to research at each stage of its development, leading to substantial improvements in study designs and customization of study protocols to their daily clinical practices. Practitioner-investigators also have helped refine the structure and function of DPBRN to foster the potential impact of research. CONCLUSIONS: Practitioners from diverse settings are partnering with fellow practitioners and academics to improve daily clinical practice and meet the needs of clinicians and their patients in DPBRN. Practice Implications. Dental PBRNs can improve clinical practice by engaging dentists in the development and implementation of studies that are of direct interest to them and their patients, and by incorporating findings from these studies into their daily clinical practice.