Qualitative evaluation of a community peer support service for people with spinal cord injury.

STUDY DESIGN: Qualitative study involving individual semistructured in-depth interviews. OBJECTIVES: To evaluate peer support provided in general hospitals for people with spinal cord injuries (SCIs). SETTING: The South West of the United Kingdom. METHODS: Fourteen in-depth qualitative interviews were conducted with people with SCI and their close relatives, and with health-care professionals involved in their care. Transcribed interviews were coded inductively and analysed thematically. Themes were patterned around positive and less positive aspects of the experience of the peer support service. RESULTS: The psychological and emotional support provided by the peer support officer was highly valued by the participants. The peer support officer's direct experience of living with a spinal injury gave credibility to the practical advice, information and signposting provided; as well as to the empathy demonstrated by them during their involvement with people with SCI and their families. Health-care professionals appreciated their unique perspective and considered them as a valuable member of the multidisciplinary team. CONCLUSION: Peer support is valued by the people affected by SCI. There is a need to further investigate the key aspects of the service, including the optimal timing for introducing this peer support as well as more formal training of mentors.

The inter rater reliability of the original and of the modified Ashworth scale for the assessment of spasticity in patients with spinal cord injury.

Thirty patients with spinal cord injury (SCI) were randomly selected to participate in this study which evaluated the inter rater reliability of the original and of the modified Ashworth scale for the assessment of spasticity in the lower limbs. A doctor and a physiotherapist rated the muscle tone of hip adductors, hip extensors, hip flexors and ankle plantarflexors according to the original and to the modified Ashworth scale. The results were analyzed using a Cohen's Kappa statistical test and showed varying levels of reliability for different muscle groups and limbs. Kappa values ranged between 0.21 and 0.61 (mean 0.37). The original scale was slightly more reliable than was the modified scale. However, this difference was not significant (P > 0.05), and was not consistent between the two limbs and between different muscle groups. It was concluded that the Ashworth scale is of limited use in the assessment of spasticity in the lower limb of patients with SCI. Further work is required to establish a standardised speed of muscle stretching during the test, or to find more appropriate grades and descriptions of spasticity for this patient group. The effects of training of the raters in the use of the scales also warrants further investigation.