Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA.
Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.
J Spinal Cord Med. 2020 Sep;43(5):653-656. doi: 10.1080/10790268.2019.1666240. Epub 2019 Sep 24.
: To determine current barriers for clinical implementation of epidural stimulation for functional improvement after spinal cord injury and highlight applicable ethical constructs to approach future research. : Survey of spinal cord injury medicine physicians, January 2019. : Spinal cord injury model systems hospital sites across the United States. : Spinal cord injury medicine physicians. : NA. : Physician-identified current barriers to clinical implementation of epidural stimulation. : The response rate for the survey was 54.6% ( = 42), with the majority of physicians (61.9%) having been asked by patients with spinal cord injuries about epidural stimulation. Numerous current barriers to clinical implementation were identified, including need for additional efficacy studies (92.9%), lack of clear guidelines on stimulation parameters (83.3%), and inability to identify which patients will benefit (76.2%). : With multiple barriers to clinical implementation currently identified, evaluating this research with an eye toward the ethical construct of equipoise is increasingly relevant. Addressing these barriers may require modifications in both physician expectations and how researchers approach this work.
：为了确定在脊髓损伤后进行硬膜外刺激以改善功能的临床实施中当前存在的障碍，并强调适用于未来研究的伦理结构。：2019 年 1 月对脊髓损伤医学医师进行了调查。：美国各地的脊髓损伤模型系统医院。：脊髓损伤医学医师。：无。：医师确定的硬膜外刺激临床实施的当前障碍。：调查的回复率为 54.6%（=42），大多数医师（61.9%）曾被脊髓损伤患者询问过硬膜外刺激。确定了许多临床实施的当前障碍，包括需要进行额外的疗效研究（92.9%）、缺乏关于刺激参数的明确指南（83.3%），以及无法确定哪些患者将受益（76.2%）。：目前存在许多临床实施的障碍，因此越来越需要用平衡伦理的角度来评估这项研究。要解决这些障碍，可能需要调整医师的期望以及研究人员处理这项工作的方式。
