Physical therapists' ability to predict future mobility after spinal cord injury.

BACKGROUND AND PURPOSE: Goal setting is an important aspect of any physical therapy program. It not only determines the focus of therapy but also determines discharge planning and equipment prescription. The effectiveness of goal setting is dependent on therapists' ability to predict patients' future mobility. The purpose of this study was to determine how accurately physical therapists can predict the future mobility of people with spinal cord injuries (SCI) at the time of admission to rehabilitation. METHODS: A cohort observational study was undertaken in 2 SCI units in Sydney, Australia, where a consecutive series of 50 patients admitted for rehabilitation was recruited. At the time of admission to rehabilitation, treating therapists predicted each patient's likely future mobility. Therapists used standardized assessment scales that captured ability to mobilize in a wheelchair, transfer, move in bed, and walk. After 3 months of standard in-patient rehabilitation, patients were reassessed by blinded assessors using the same scales. Therapists' predictions on admission were compared with patients' outcomes at 3 months. RESULTS: There was a strong positive correlation between therapists' predictions on admission and patients' outcomes at 3 months (r = 0.53-0.92). Therapists' predictions were within 1 point of patient outcomes between 60% and 78% of the time. DISCUSSION AND CONCLUSION: Physical therapists are able to accurately predict future mobility of people with SCI at the time of admission to rehabilitation. Ability to accurately predict future mobility is necessary for goal setting and for ensuring that therapy, discharge planning, and equipment prescription are appropriate. These findings are important because they indicate how much confidence patients, funders, policy makers, and administrators can have in therapists' ability to predict patients' future mobility.

Accuracy of physiotherapists' predictions for mobility outcomes at 1-year post spinal cord injury.

The primary objective of this study was to determine the accuracy of physiotherapists' predictions of mobility for people with spinal cord injury (SCI). Five physiotherapists and 47 patients from two SCI units were recruited. Two sets of predictions about mobility at 1 year were made for each patient shortly after they commenced rehabilitation. The predictions were made using standardized outcome measures. One set of predictions was made by the physiotherapists from the patients' SCI unit who had face-to-face contact with the patients and the other set of predictions was made by the physiotherapists from the other SCI unit who had no face-to-face contact with the patients and instead relied on chart records, and vice versa for patients from the second SCI unit. Correlations between mobility at 1 year and the predictions made by the physiotherapists who had face-to-face contact with the patients ranged between 0.54 and 0.85. The corresponding correlations for the physiotherapists who did not have face-to-face contact ranged between 0.40 and 0.71. Contact and non-contact physiotherapists' predictions were within one point of outcomes between 55% and 83% of the time. Physiotherapists were reasonably accurate at predicting future mobility. Face-to-face contact with patients slightly improved the accuracy of predictions.

Functional electrical stimulation cycling has no clear effect on urine output, lower limb swelling, and spasticity in people with spinal cord injury: a randomised cross-over trial.

QUESTION: Does functional electrical stimulation (FES) cycling increase urine output and decrease lower limb swelling and spasticity in people with recent spinal cord injury? DESIGN: Randomised cross-over trial. PARTICIPANTS: Fourteen participants with a recent motor complete spinal cord injury were consecutively recruited from two spinal cord injury units in Sydney. INTERVENTION: Participants were randomised to an experimental phase followed by a control phase or vice versa, with a 1-week washout period in between. The experimental phase involved FES cycling four times a week for two weeks and the control phase involved standard rehabilitation for two weeks. Assessments by a blinded assessor occurred at the beginning and end of each phase. Allocation was concealed and an intention-to-treat analysis was performed. OUTCOME MEASURES: The primary outcome was urine output (mL/hr) and the secondary outcomes were lower limb circumference, and spasticity using the Ashworth Scale, and the Patient Reported Impact of Spasticity Measure (PRISM). In addition, participants were asked open-ended questions to explore their perceptions about treatment effectiveness. RESULTS: All participants completed the study. The mean between-group difference (95% CI) for urine output was 82mL/hr (-35 to 199). The mean between-group differences (95% CI) for lower limb swelling, spasticity (Ashworth), and PRISM were -0.1cm (-1.5 to 1.2), -1.9 points (-4.9 to 1.2) and -5 points (-13 to 2), respectively. All point estimates of treatment effects favoured FES cycling. Participants reported many benefits from FES cycling. CONCLUSION: There were no clear effects of FES cycling on urine output, swelling and spasticity even though all point estimates of treatment effects favoured FES cycling and participants perceived therapeutic effects. TRIAL REGISTRATION: ACTRN12611000923965.