Development and Implementation of a Universal Standing and Walking Assessment Tool (SWAT) for Spinal Cord Injury during the Rehabilitation Process
1Walden K, 2Verrier M, 3Mussleman K, 4Gagnon D, 5Lemay J, 6Guy K
1Rick Hansen Institute, Vancouver, BC, Canada; 2Departments of Physical Therapy, Rehabilitation Science, Institute of Medical Science and Physiology, Faculty of Medicine University of Toronto and University Heath Network-Toronto Rehabilitation Institute, Lyndhurst Centre, Toronto, ON, Canada; 3University Health Network, Toronto, ON, Canada; 4Université de Montréal, Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Institut de réadaptation Gingras- Lindsay-de-Montréal, Montreal, QC, Canada; 5Institut de readaptation Gingras-Lindsay-de-Montreal, Montreal, QC, Canada; 6Toronto Rehabilitation Institute, Toronto, ON, Canada
Objective: Spinal cord injury (SCI) often causes sensorimotor impairments of the lower extremities making standing and walking an important rehabilitation goal. Many tools for assessing standing and walking in SCI exist(1,2); however, there is no consensus nationally or internationally on which instruments to use during the rehabilitation process. More importantly there is no consensus nationally or internationally on what stage of functional recovery to initiate specific assessments for standing and walking.
The objective of this project was to develop and implement a SWAT for inpatient rehabilitation at Canadian Rick Hansen Spinal Cord Injury Registry (RHSCIR) rehabilitation centers to: inform evidence-based physical therapy practice, improve efficiencies in service delivery, and to evaluate innovative approaches to improve ambulation.
Design/Method: There were four phases in this project: 1. Engagement of a group of researchers and expert clinicians to form a Canadian SCI Standing and Walking Measures (SWM) development group. 2. Development of a robust SWAT. 3. Confirmation of SWAT Face Validity. 4. SWAT implementation into clinical practice. Development and implementation used the Consolidation Framework for Implementation Research (CFIR) model(3). The RHSCIR was used to support data collection and dissemination. Physical therapists and researchers from eight Canadian inpatient rehabilitation centers participated in SWAT development. Development included a review of existing evidence, standing and walking assessment practices, and clinical feasibility. A new functional staging tool was designed outlining different stages of standing and walking recovery. Walking stages were determined using a consensus-based approach incorporating regular feedback from frontline clinicians. The staging tool captures a wide range of function from those who cannot sit independently with no lower extremity function to those who can independently ambulate long distances. Outcome measures (OM’s) appropriate for each stage are indicated and completed during inpatient rehabilitation at admission and discharge if the patient is at or above the defined threshold stage for that measure.
Five OM’s were included: Berg Balance Scale, 10 Meter and 6 Minute Walk Tests, Timed Up and Go, and the Activities Specific Balance Confidence Scale. Two optional measures for research purposes were also collected: Spinal Cord Injury Functional Ambulation Profile, and the mini-Balance Evaluation Systems Test.
Implementation began with development of the Standing and Walking Measures Toolkit(4) Lead clinicians at each center received standardized training and act as champions at their hospital.
Results:Most hospitals began completing the SWAT in April 2014. To date the SWAT have been completed on over 500 patients with traumatic SCI and a ninth hospital has joined the project.
Conclusion:The SWAT is a universal assessment tool for standing and walking at standardized stages of recovery after SCI. It has been implemented at nine Canadian Rehabilitation centers and is currently being validated and updated.
Support:This project is supported by the Rick Hansen Institute and Western Economic Diversification
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