Health Services Research and Development Service, Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines, Illinois, USA.
Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
J Spinal Cord Med. 2022 Jan;45(1):33-41. doi: 10.1080/10790268.2021.1890680. Epub 2021 Mar 11.
CONTEXT/OBJECTIVE: The risk of lower extremity (LE) fractures in persons with spinal cord injury or disorders (SCI/D) is double that of the able-bodied population. LE fractures are the most common fracture location in SCI/D. Physical therapists (PTs) and occupational therapists (OTs) play an important role in rehabilitating LE fractures in Veterans with SCI/D. This paper describes their role in assisting persons with SCI/D and LE fractures to return to previous function and levels of participation.
Cross-sectional semi-structured interviews were conducted by telephone. Setting: VA SCI centers.
Purposive sample of therapists (PTs and OTs) experienced in LE fracture rehabilitation in SCI/D Interventions: NA.
Coding of responses used a data-driven thematic and deductive approach, dictated by a semi-structured interview guide addressing the entire treatment process.
Participants strongly advocated for early PT/OT involvement in post-fracture rehabilitation in order to recommend braces and devices to minimize skin breakdown, and needs for patient equipment, skills training and/or caregiver assistance resulting from post-fracture mobility changes. Seating specialists should be involved in post-fracture seating assessments in wheelchair users to address changes in alignment, deformities, limb length discrepancies and/or seating posture during and following fracture management.
PTs and OTs are critical in rehabilitating LE fractures in persons with SCI/D and LE fractures, bringing expertise in patient function, ambulatory status, transfer strategies, mobility equipment, spasticity, lifestyle, and home and caregiver support. Involving them early in the rehabilitation process, along with orthopedic surgeons, physiatrists and other SCI clinicians can address the multiple and often unique issues that occur in managing fractures in this population.
背景/目的：脊髓损伤或疾病（SCI/D）患者下肢（LE）骨折的风险是健全人群的两倍。LE 骨折是 SCI/D 中最常见的骨折部位。物理治疗师（PTs）和作业治疗师（OTs）在康复 SCI/D 患者的 LE 骨折方面发挥着重要作用。本文描述了他们在帮助 SCI/D 和 LE 骨折患者恢复先前功能和参与水平方面的作用。
通过电话进行横截面半结构式访谈。地点：VA SCI 中心。
具有 SCI/D 中 LE 骨折康复经验的治疗师（PTs 和 OTs）的目的性抽样。干预措施：无。
使用数据驱动的主题和演绎方法对响应进行编码，这是由一个半结构式访谈指南决定的，该指南涵盖了整个治疗过程。
参与者强烈主张在骨折后康复中尽早让 PT/OT 参与，以便推荐支具和设备，以最小化皮肤破裂，以及由于骨折后移动性变化而需要患者设备、技能培训和/或护理人员协助。在轮椅使用者中，应让座椅专家参与骨折后的座椅评估，以解决对线、畸形、肢体长度差异和/或骨折管理期间和之后的坐姿变化。
PTs 和 OTs 在康复 SCI/D 和 LE 骨折患者的 LE 骨折方面至关重要，他们具有患者功能、步行状态、转移策略、移动设备、痉挛、生活方式以及家庭和护理人员支持方面的专业知识。让他们与骨科医生、物理治疗师和其他 SCI 临床医生一起在康复过程早期参与，可以解决管理该人群骨折时出现的多个且通常是独特的问题。
