Implementation of a Standardized Dataset for Collecting Information on Patients With Spinal Cord Injury.

Background: Over the last decade, the International Spinal Cord Injury Data Sets project developed a number of International Spinal Cord Injury Data Sets (ISCIDS) that can be used to collect standardized information on patients with SCI. Objective and Methods: The aim of this article is to describe the process of translating the ISCIDS into Dutch and reaching consensus on a Dutch National SCI Data Set (NDD). The interrater reliability of the NDD and implementation of the NDD at eight rehabilitation centers with a specialty in rehabilitation after SCI in the Netherlands are described. Results: NDD was implemented successfully at all eight centers. Some adaptations were made to the ISCIDS, especially to the core data set. The reliability coefficients of the NDD items were at least sufficient (mean kappa per data set ranged between .68 and .91), and mean agreement per data set ranged from 66% to 97%. Experiences from the participating centers were mainly positive as well. The main obstacle for use was thought to be the absence of a link between the local patient files and the national database, which necessitates double data entry. Conclusion: Although the results on interrater reliability are based on a small sample size and the assessment situation is different from the normal clinical situation, this study showed the NDD to be a useful instrument to collect standardized information on patients with SCI in the Netherlands. In the future, a connection between systems or another way to centrally collect the data is recommended to prevent double data entry and to guarantee continuation of administration of the NDD.

Progress of the Dutch Spinal Cord Injury Database: Completeness of Database and Profile of Patients Admitted for Inpatient Rehabilitation in 2015.

Background: In the Dutch International Spinal Cord Injury (SCI) Data Sets project, we translated all International SCI Data Sets available in 2012 and created a Dutch SCI Database (NDD). Objective: To describe the number of included patients and completeness of the NDD, and to use the NDD to provide a profile of people with traumatic SCI (T-SCI) and non-traumatic SCI (NT-SCI) in the Netherlands. Methods: The NDD includes patients admitted for their first inpatient rehabilitation after onset of SCI to 1 of the 8 rehabilitation centers with a specialty in SCI rehabilitation in the Netherlands. Data of patients admitted in 2015 were analyzed. Results: Data for 424 patients were available at admission; for 310 of these patients (73.1%), discharge data were available. No significant differences were found between patients with and without data at discharge. Data were nearly complete (>90%) for lower urinary tract, bowel, pain, and skin. Data on sexual function has the lowest completion rate. Complete neurological and functional data were available for 41.7% and 38%, respectively. Most patients were male (63.4%), had NT-SCI (65.5%), and had incomplete SCI (58.4% D). Patients with T-SCI differed from patients with NT-SCI on most characteristics, and they stayed considerably longer in the rehabilitation center (112 days vs 65 days, p < .001). Place of discharge was not different between both groups. Conclusion: With the NDD, we collect important data on the majority of Dutch SCI patients, although much work needs to be done to improve the completeness of the data collection.

Comparing content of therapy for people with a spinal cord injury in postacute inpatient rehabilitation in Australia, Norway, and The Netherlands.

BACKGROUND: Research reports have described the contents of therapy in spinal cord injury (SCI) rehabilitation only as the total number of therapy hours. We developed the Spinal Cord Injury-Interventions Classification System (SCI-ICS) as a tool to classify therapy to improve mobility and self-care into 3 levels (body functions, basic activities, and complex activities) and 25 categories. OBJECTIVE: The purposes of this study were: (1) to compare specific contents and amount of therapy provided, with the aim of improving mobility and self-care for people with SCI in Australia, Norway, and the Netherlands and (2) to evaluate the use of the SCI-ICS outside the Netherlands. DESIGN: This was a prospective, descriptive study. METHODS: Physical therapists, occupational therapists, and sports therapists in 6 centers recorded all therapy provided to all people with a recent SCI in inpatient rehabilitation during 4 designated weeks. Each treatment session was classified using 1 or more SCI-ICS codes. Duration of each intervention was specified. RESULTS: Seventy-three therapists recorded 2,526 treatments of 79 people with SCI (Netherlands, 48; Australia, 20; Norway, 11). Most therapy time was spent on exercises (overall mean=84%) and on categories at body function and basic activity level of the SCI-ICS. Therapy time significantly differed among countries for 13 of 25 categories. Mean time in minutes per treatment (Netherlands, 28; Australia, 43; Norway, 39) and in hours per patient per week (Netherlands, 4.3; Australia, 5.8; Norway, 6.2) differed significantly. LIMITATIONS: The short period and small number of patients may have influenced the results. CONCLUSIONS: Therapy in inpatient SCI rehabilitation in all 3 countries focused on mobility and self-care exercises at body function and basic activity level, but differences were present in focus on the various categories and therapy time. The SCI-ICS can be used reliably to describe therapy in different countries.

Contents of physical therapy, occupational therapy, and sports therapy sessions for patients with a spinal cord injury in three Dutch rehabilitation centres.

PURPOSE: To describe the contents of interventions to improve self-care and mobility for patients with spinal cord injury (SCI) in early post-acute rehabilitation, using the Spinal Cord Injury-Interventions Classification System (SCI-ICS), and to compare these interventions between rehabilitation centres. The SCI-ICS describes therapy to improve self-care and mobility at three levels of functioning and consists of 25 categories with a total of 139 different interventions. METHODS: Fifty-three physical therapists, occupational therapists and sports therapists of three Dutch SCI rehabilitation centres recorded interventions with the SCI-ICS for patients with SCI in early post-acute rehabilitation for four consecutive weeks. RESULTS: Therapists recorded 1640 treatment sessions of 48 patients with a SCI. The mean number of treatment sessions per patient per week (8.9 overall) differed between centres (p < 0.05), unlike the mean therapy time in minutes per patient per week (259 overall). Highest frequencies for individual categories were found for 'Muscle Power', 'Walking', and 'Hand rim wheelchair propulsion'. CONCLUSIONS: We described the specific contents of therapy of patients with a SCI in three Dutch rehabilitation centres. The largest proportion of time was spent on interventions to improve muscle power, walking, and hand rim wheelchair propulsion.

Reliability of a new classification system for mobility and self-care in spinal cord injury rehabilitation: the Spinal Cord Injury-Interventions Classification System.

OBJECTIVE: To investigate the reliability of the Dutch version of the Spinal Cord Injury-Interventions Classification System. DESIGN: Descriptive study. SETTING: Three Dutch spinal cord injury facilities. PARTICIPANTS: Six physical therapists, 6 occupational therapists, and 3 sports therapists. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A 4- or 5-digit code was used to score videotaped interventions on 2 occasions in terms of level, category, and type of intervention. We examined the percentage of correctly assigned interventions (agreement between the researcher and the participants), agreement between the first and second measurements (intrarater reliability), and agreement between the therapists of the same discipline (interrater reliability). RESULTS: A total of 252 interventions were assigned. The agreement between the researcher and the participants was good: the percentage of correct interventions was high at both measurements (91.7% and 94.4%). Intrarater agreement was also good (90.9%). The interrater agreement within the physical therapists and the occupational therapists was high at both occasions (mean, 92.3% and 87.0%, respectively), but lower within the sports therapists (mean, 69.3%). CONCLUSIONS: The study provided first evidence for reliability of the classification system. Further research is needed to confirm these results and to test the reliability of other language versions.

Feasibility of a classification system for physical therapy, occupational therapy, and sports therapy interventions for mobility and self-care in spinal cord injury rehabilitation.

OBJECTIVE: To test the feasibility of a classification system developed to record the contents of treatment sessions intended to improve mobility and self-care by persons with a spinal cord injury (SCI) in clinical rehabilitation. DESIGN: Descriptive study. SETTING: Three Dutch SCI facilities. PARTICIPANTS: Participants (N=36) as well as physical therapists (n=20), occupational therapists (n=14), and sports therapists (n=2). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Questionnaires to assess the clarity of the classification system, time needed to record 1 treatment session, and the distribution of categories and interventions. The classification system consisted of 28 categories at 3 levels of functioning: basic functions (eg, muscle power), basic activities (eg, transfers), and complex activities (eg, walking and moving around outside). RESULTS: Therapists used 1625 codes to record 856 treatment sessions of 142 patients. For 93% of the treatment sessions, the coding caused little or no doubt. The therapists were able to classify 86.3% of the treatment sessions within 3 minutes. The classification system was rated as useful and easy to use. CONCLUSIONS: The findings support the suitability of our classification system as a tool to record the contents of SCI treatment sessions in different settings and by different therapists.

Development of a classification of physical, occupational, and sports therapy interventions to document mobility and self-care in spinal cord injury rehabilitation.

OBJECTIVE: To describe the development of a classification for therapeutic activities in clinical spinal cord injury (SCI) rehabilitation. DESIGN: Descriptive study including a modified Delphi consensus method. SETTING: Specialized SCI units of 10 rehabilitation facilities. PARTICIPANTS: Thirty physical therapists, occupational therapists, and sports therapists from 10 Dutch and Flemish SCI centers. MAIN OUTCOME MEASURES: Identification of the levels, categories, and interventions; level of agreement among experts with (1) definitions, (2) terminology, (3) relevance, and (4) completeness of the classification (consensus considered sufficient if 80% or more agree). RESULTS: The classification comprises three levels of functioning: basic functions, basic activities, and complex activities. The three levels comprise 28 categories within which interventions are listed. Sufficient consensus was obtained for the definitions of the three levels (range, 87%-100%). Percentages of consensus for the terminology used and the completeness of the categories ranged from 75% to 100%. The perceived relevance of the categories for everyday work varied per discipline. CONCLUSION: A potentially useful classification was developed to record clinical treatment sessions in physical therapy, occupational therapy, and sports therapy for persons with SCI. The classification is currently being tested in ongoing research.