Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.
Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, Virginia, USA.
J Spinal Cord Med. 2020 Jul;43(4):421-427. doi: 10.1080/10790268.2019.1645415. Epub 2019 Aug 12.
: Scoping review : To study the design, clinical setting and outcome measures used in spinal cord injury rehabilitation publications. : A literature search on PubMed and Medline was conducted focusing on articles published between 1990-2016 and using "traumatic SCI", "functional outcomes", "rehabilitation", "work" and "return to work" as outcomes. Studies were categorized based on design (intervention, including RCTs vs. non-intervention studies), settings (inpatient vs. outpatient vs. transition), and outcome measures used (impairment vs. function vs. participation/integration vs. quality of life vs. symptoms). Work-related studies were categorized independently. : Five hundred forty-four articles met the inclusion criteria. Of these, 234 were interventional studies, including 23 RCTs. Studies were evenly divided among inpatient, outpatient and transition settings. Of the 234 interventional studies, 143 used functional evaluations. Sixty-one different functional instruments were used, with a predominant use of the Functional Independence Measure (61 times) and an additional use of SCI-specific measures, i.e. Spinal Cord Independence Measure and Craig Handicap Assessment and Reporting Technique (13 times each). Fifty-one studies measured mobility, while only three measured hand functions. The work-related sub-analysis revealed 32 intervention studies (no RCTs), of which 15 used functional evaluations and only three focused on tetraplegia. : Our study revealed a paucity of intervention trials and RCTs, indicating a dearth of knowledge that would be needed to establish evidence-based practice guidelines. This is particularly true for tetraplegia. While standard measures of function were frequently used, providing valuable data, there is no consensus about what exact outcome measure to use. Using newer measurement techniques, for instance based on the application of item response theory, should be considered to enhance uniformity.
研究脊髓损伤康复文献中使用的设计、临床环境和结果测量。
在 PubMed 和 Medline 上进行了文献检索，重点关注 1990-2016 年期间发表的文章，并使用“创伤性脊髓损伤”、“功能结果”、“康复”、“工作”和“重返工作”作为结果。研究根据设计（干预，包括 RCT 与非干预研究）、环境（住院、门诊与过渡）和使用的结果测量（损伤、功能、参与/融入、生活质量、症状）进行分类。与工作相关的研究单独分类。
符合纳入标准的有 544 篇文章。其中，234 篇为干预研究，包括 23 项 RCT。研究在住院、门诊和过渡环境中均匀分布。在 234 项干预研究中，143 项使用了功能评估。使用了 61 种不同的功能工具，其中功能独立性测量（61 次）和脊髓损伤特异性测量（即脊髓独立性测量和 Craig 残疾评估和报告技术，各 13 次）使用更为普遍。51 项研究测量了移动能力，而只有 3 项研究测量了手部功能。与工作相关的子分析显示有 32 项干预研究（无 RCT），其中 15 项使用了功能评估，只有 3 项研究集中于四肢瘫痪。
我们的研究表明，干预试验和 RCT 较少，表明缺乏建立循证实践指南所需的知识。这对于四肢瘫痪尤其如此。虽然常用标准功能测量方法提供了有价值的数据，但对于使用何种确切的结果测量方法尚未达成共识。应考虑使用新的测量技术，例如基于项目反应理论的应用，以提高一致性。
