Fehlings Michael G, Tetreault Lindsay A, Aarabi Bizhan, Anderson Paul, Arnold Paul M, Brodke Darrel S, Chiba Kazuhiro, Dettori Joseph R, Furlan Julio C, Harrop James S, Hawryluk Gregory, Holly Langston T, Howley Susan, Jeji Tara, Kalsi-Ryan Sukhvinder, Kotter Mark, Kurpad Shekar, Kwon Brian K, Marino Ralph J, Martin Allan R, Massicotte Eric, Merli Geno, Middleton James W, Nakashima Hiroaki, Nagoshi Narihito, Palmieri Katherine, Singh Anoushka, Skelly Andrea C, Tsai Eve C, Vaccaro Alexander, Wilson Jefferson R, Yee Albert, Burns Anthony S
Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
University of Toronto, Toronto, Ontario, Canada.
Global Spine J. 2017 Sep;7(3 Suppl):231S-238S. doi: 10.1177/2192568217701910. Epub 2017 Sep 5.
The objective of this study is to develop guidelines that outline the appropriate type and timing of rehabilitation in patients with acute spinal cord injury (SCI).
A systematic review of the literature was conducted to address key questions related to rehabilitation in patients with acute SCI. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the type and timing of rehabilitation. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as "we recommend," whereas a weaker recommendation is indicated by "we suggest.
Based on the findings from the systematic review, our recommendations were: (1) We suggest rehabilitation be offered to patients with acute spinal cord injury when they are medically stable and can tolerate required rehabilitation intensity (no included studies; expert opinion); (2) We suggest body weight-supported treadmill training as an option for ambulation training in addition to conventional overground walking, dependent on resource availability, context, and local expertise (low evidence); (3) We suggest that individuals with acute and subacute cervical SCI be offered functional electrical stimulation as an option to improve hand and upper extremity function (low evidence); and (4) Based on the absence of any clear benefit, we suggest not offering additional training in unsupported sitting beyond what is currently incorporated in standard rehabilitation (low evidence).
These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in patients with SCI by promoting standardization of care, decreasing the heterogeneity of management strategies and encouraging clinicians to make evidence-informed decisions.
本研究的目的是制定指南，概述急性脊髓损伤（SCI）患者康复的适当类型和时机。
对文献进行系统回顾，以解决与急性SCI患者康复相关的关键问题。一个多学科指南制定小组利用这些信息及其临床专业知识，制定康复类型和时机的建议。基于GRADE（推荐分级、评估、制定和评价），强烈推荐表述为“我们建议”，而较弱的推荐则用“我们建议”表示。
基于系统回顾的结果，我们的建议如下：（1）我们建议在急性脊髓损伤患者病情稳定且能够耐受所需康复强度时为其提供康复治疗（无纳入研究；专家意见）；（2）我们建议除传统的地面行走训练外，根据资源可用性、背景和当地专业知识，将体重支持的跑步机训练作为步行训练的一种选择（证据质量低）；（3）我们建议为急性和亚急性颈髓损伤患者提供功能性电刺激，作为改善手部和上肢功能的一种选择（证据质量低）；（4）基于没有任何明确益处，我们建议除目前标准康复中已包含的内容外，不提供额外的无支撑坐位训练（证据质量低）。
这些指南应在临床实践中实施，以通过促进护理标准化、减少管理策略的异质性以及鼓励临床医生做出基于证据的决策，改善SCI患者的预后并降低发病率。
