The Spinal Cord Injury - Interventions Classification System:
development and evaluation of a documentation tool to record therapy to
improve mobility and self-care in people with spinal cord injury
Sacha van Langeveld, PT (Researcher)
Marcel Post, PhD (Project leader)
Floris van Asbeck, MD, PhD
Karin Postma, MsC, PT
J. Leenders, OT
Cees Pons, MD
Hans Liefhebber, manager
On July 8, 2010, Sacha van Langeveld defended her dissertation entitled:
The Spinal Cord Injury-Interventions Classification System (SCI-ICS)
Summary
Chapter 1, the introduction, describes the
rationale and the main aims of the research project and presents an outline of
this thesis. lnpatient rehabilitation in specialized spinal cord injury units
is regarded worldwide as the best treatment for the complex consequences of
spinal cord injury. However, little is known about the elements that make this
the 'best treatment'. To date, therapy provided in rehabilitation has only
been recorded for administrative purposes: the number of treatments, the hours
of therapy, and by whom it is provided (e.g. physical therapists, ccupational
therapists). Since there is no instrument to record therapy time, nor the
contents of therapy, it is impossible to compare rehabilitation treatments
between patients, centers and countries. The research described in this thesis
focused on the development and evaluation of a clear, uniform, reliable and
complete classification system of interventions used by physical therapists,
occupational therapists and sports therapists to improve the mobility and
self-care of patients with a spinal cord injury. This classification system
enables the contents of treatments to be identified, information that can be
used to improve the effectiveness and efficiency of inpatient rehabilitation
of patients with a spinal cord injury.
Chapter 2
describes how the first version
of the classification system, which was later named the Spinal Cord
lnjury-lnterventions Classification System (SCl-ICS ), was tested in a
modified Delphi consensus procedure. The main aim of this study was to reach
consensus about definitions of the levels, the categories and interventions in
the system and to refine them if necessary. A total of 30 therapists from 10
Dutch and Flemish specialized SCI rehabilitation centers completed the first
and second Delphi rounds. The results showed that the SCI-ICS met with high
levels of consensus among the therapists in terms of the definitions of the 3
levels (range 87%-100%), the terminology used and the completeness of the
classification (range 75%-100%). The perceived relevance of the categories for
therapists' everyday work differed between disciplines. We concluded that the
SCI-ICS seemed a potentially useful classification system to record clinical
treatment sessions in physical therapy, occupational therapy and sports
therapy for persons with spinal cord injury.
In Chapter 6 we describe and compare the
contents of physical therapy, occupational therapy and sports therapy for
patients with a spinal cord injury in post-acute inpatient rehabilitation in
Australia, Norway and the Netherlands. Seventy-three therapists used the
SCI-ICS to record 2526 treatments of 79 patients with a recently acquired
spinal cord injury (48 in the Netherlands, 20 in Australia and 11 in Norway) during 4 consecutive
weeks. As part of the procedure, the reliability of the English-language
version of the SCI-ICS used by the Australian and Norwegian staff was tested,
and proved to be good. Again, we found in all countries that by far the
largest proportion of time (92% overall) was spent on mobility and self-care
interventions. There were differences between the countries in the mean time
spent per treatment (28 minutes in the Netherlands, 43 in Australia and 39 in Norway), and the total
time per patient per week (4.3 hours in the Netherlands, 5.8 in Australia and
6.2 in Norway). Key similarity was the focus on exercises at the body function
and basic activity levels, and the small proportion of time spent on task- and
context-specific interventions at the complex activity level. Most therapy
time was spent on 'Muscle Power' (all countries), 'Muscle Length' (Norway),
'Walking' (the Netherlands), and 'Transfers' (Australia).There were 13
categories for which the mean time spent per patient per week differed between
the countries, controlled for type of SCI. We concluded that the SCI-ICS makes
it possible to compare the contents of therapy between countries.
Chapter 7
presents the main conclusions of
this thesis and a general discussion of our findings. Firstly, we successfully
developed the SCI-ICS as an instrument to document treatment sessions by
physical therapists, occupational therapists and sports therapists for the
main domains of spinal cord injury rehabilitation, namely mobility and
self-care. The SCI-ICS is:
- sufficiently complete;
-quick and easy to use;
-a reliable instrument which can be used by
different therapists from different settings and countries.
Second, we used the SCI-ICS to study spinal cord
injury therapy programmes in different rehabilitation centers in different
countries:
-The 3 centers in the Netherlands provided
similar therapy.
-In all 5 settings of the 3 countries, most of
the overall time was spent on mobility and self-care interventions, and on
exercises.
-There were differences between the 3 countries
in the time spent on treatments and in the therapy focus.
-There is a degree of overlap between treatments
in physical therapy, occupational therapy and sports therapy for spinal cord
injury rehabilitation.
You can read more information about this project in the Dutch or English newsletter.
List of publications
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Development of a classification of physical, occupational, and sports therapy interventions to document mobility and self-care in spinal cord injury rehabilitation. Van Langeveld SA, Post MW, van Asbeck FW, Postma K, Ten Dam D, Pons K. J Neurol Phys Ther. 32(1):2-7, 2008.
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Feasibility of a classification system for physical therapy, occupational therapy, and sports therapy interventions for mobility and self-care in spinal cord injury rehabilitation. van Langeveld SA, Post MW, van Asbeck FW, Postma K, Leenders J, Pons K. Arch Phys Med Rehabil. 89(8):1454-9, 2008.
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Reliability of a new classification system for mobility and self-care in spinal cord injury rehabilitation: the spinal cord injury-interventions classification system. van Langeveld SA, Post MW, van Asbeck FW, Ter Horst P, Leenders J, Postma K, Lindeman E. Arch Phys Med Rehabil. 90(7): 1229-36, 2009.
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Contents of physical therapy, occupational therapy, and sports therapy sessions for patients with a spinal cord injury in three Dutch rehabilitation centres. van Langeveld SA, Post MW, van Asbeck FW, Ter Horst P, Leenders J, Postma K, Rijken H, Lindeman E. Disabil Rehabil 2010.
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Comparing contents of therapy for people with a spinal cord injury in postacute inpatient rehabilitation in Australia, Norway, and the Netherlands. van Langeveld SA, Post MW, van Asbeck FW, Gregory M, van der Meer Halvorsen A, Leenders J, Postma K, Rijken H, Lindeman E. Submitted 2010.
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