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.

Disuse and deconditioning in chronic low back pain: concepts and hypotheses on contributing mechanisms.

For years enhancement of a patient's level of physical fitness has been an important goal in rehabilitation treatment in chronic low back pain (CLBP), based on the hypothesis that physical deconditioning contributes to the chronicity of low back pain. However, whether this hypothesis in CLBP holds is not clear. In this paper, possible mechanisms that contribute to the development of physical deconditioning in CLBP, such as avoidance behaviour and suppressive behaviour, are discussed. The presence of both deconditioning-related physiological changes, such as muscle atrophy, changes in metabolism, osteoporosis and obesity as well as deconditioning related functional changes, such as a decrease in cardiovascular capacity, a decrease in muscle strength and impaired motor control in patients with CLBP are discussed. Results of studies on the level of physical activities in daily life (PAL) and the level of physical fitness in patients with CLBP compared to healthy controls were reviewed. In studies on PAL results that were either lower or comparable to healthy subjects were found. The presence of disuse (i.e., a decrease in the level of physical activities in daily life) in patients with CLBP was not confirmed. The inconclusive findings in the papers reviewed may partly be explained by different measurement methods used in research on PAL in chronic pain. The level of physical fitness of CLBP patients also appeared to be lower or comparable to the fitness level of healthy persons. A discriminating factor between fit and unfit patients with back pain may be the fact that fit persons more frequently are still employed, and as such may be involved more in physical activity. Lastly some suggestions are made for further research in the field of disuse and deconditioning in CLBP.