Physio and OT experts develop best expected outcomes tool for people with spinal cord injury

The spinal cord injury first episode of rehabilitation therapy outcomes (SCIFERTO) tool is an expert, multidisciplinary resource that defines the expected maximal clinical outcomes.

It was developed by a specialist group of physios and occupational therapists, who work as spinal cord injury therapy leads (SCITLs) at specialist centres in the UK and Ireland.

Benita Hexter, a clinical specialist and lead physiotherapist at the London Spinal Cord Injury Centre, is part of the SCITLS group. She told Frontline: ‘There are only 12 spinal cord injury centres across the UK and Ireland.

‘But people with spinal cord injury present in so many settings other than the specialist centres, and we consider it part of our role to share our knowledge and support services in providing good care for all patients, not just those in our centres.

‘So we have developed this tool to influence SCI therapy service provision nationally and internationally.

‘When working with someone with SCI for the first time, making sense of what can be achieved is difficult and the negative consequences of poor treatment are considerable.

‘So the SCIFERTO tool offers a complete guide to what therapists may look to achieve from which they can derive a treatment plan with reference to the patient’s individual presentation and needs.’

Five years in the making

In 2011, the SCITLs group began compiling a list of expected outcomes for people who are experiencing their first episode of SCI rehabilitation. The therapy leads then discussed and debated the list, in interdisciplinary and inter-centre groups, until a first draft of the tool was agreed.

The draft version then underwent thorough review, including a five-year trial by experienced clinicians, before a final version was approved in 2016.

By developing the tool the group aimed to

• give clinicians of all levels of experience a tool to facilitate choice of treatment pathways and expectation setting with patients and the broader MDT and to support clinical supervision
• provide a description of clinical services that should be offered to underpin the development of facilities in spinal cord injury centres
• contribute to the provision of an appropriate skill set for OTs and physios who specialise in spinal cord injury, by providing a definition of the clinical services they should be able to provide
• supplement existing SCI standards, which will allow thorough and detailed benchmarking of services

Outcomes achieved by physios and OTs

The tool provides an outline of all the areas of need addressed by SCI physios and OTs, such as mobility, wheelchair seating and skills, activities of daily living, management of strength, spasticity, range of movement, pain, cardiovascular fitness, respiratory needs and oedema management.

It also provides information about related issues, such as access to equipment and vocational and leisure considerations like swimming and driving.

The best practice resource is free to download from the Multidisciplinary Association of Spinal Cord Injury Professionals (MASCIP) website.