SCIRehab Project series: the therapeutic recreation taxonomy.

BACKGROUND/OBJECTIVE: Outcomes research of therapeutic recreation (TR) activities and interventions for spinal cord injury (SCI) rehabilitation is made more difficult by a lack of uniform descriptions and the absence of a formal treatments classification system (taxonomy). The objective of this study was to describe a taxonomy developed by Certified Therapeutic Recreation Specialists. METHODS: TR lead clinicians and researchers from 6 SCI rehabilitation centers developed a TR documentation system to describe the details of each TR session involving patients with SCI enrolled in the SCIRehab study. The SCIRehab study uses the practice-based evidence methodology, a rigorous observational methodology that examines current practice without introducing additional treatments, to capture details of each TR session for 1,500 SCI rehabilitation patients at 6 US inpatient SCI rehabilitation facilities. This may be the first attempt to document the many details of the TR rehabilitation process for patients with SCI. RESULTS: The TR taxonomy consists of 6 activities (eg, leisure education and counseling, outings, and leisure skill work in center) and activity-specific interventions, as well as time spent on each activity. Activity descriptions are enhanced with additional details that focus on assistance needs for each activity, patient ability to direct care, and patient/family involvement, which may help to determine TR activity selection. CONCLUSION: Development and application of a TR taxonomy, which is comprehensive for patients with SCI and efficient to use, are feasible despite significantly different TR programs at the 6 SCIRehab centers.

SCIRehab Project series: the social work/case management taxonomy.

CONTEXT: Social work and case management (SW/CM) are integral components of acute inpatient spinal cord injury (SCI) rehabilitation. However, evidence is sparse regarding the impact of SW/CM interventions on outcomes. To advance research on SW/CM clinical practice in SCI rehabilitation, SW/CM providers and researchers first must have standard classifications for SW/CM interventions. BACKGROUND/OBJECTIVE: To develop a taxonomy (classification) of the various interventions and services that comprise SW/CM. METHODS: A group of SW/CM clinicians compiled a list of activities performed as routine practice at the participating rehabilitation facilities. These activities were grouped and defined systematically. RESULTS: The resulting taxonomy includes 8 major activity topics (financial planning, discharge planning, discharge services, supportive counseling, information about and referral to peer/advocacy groups, education about SCI and other relevant topics, information about and referral to community/in-house services, and team conferences), which were further stratified into specific content areas. Interactions with the patient, family, or other team members and resources, along with descriptions of the interactions that are applicable to each of the 8 activity topics, were included as well. CONCLUSION: An intervention taxonomy is required to study the SW/CM interventions and the potential association with positive rehabilitation outcomes for patients with SCI. The SW/CM taxonomy developed for the SCIRehab project, which will be used with 1,500 patients admitted to 6 SCIRehab centers over 2.5 years, will provide an infrastructure for such research.