McBain Candice, Sarandrea Anne Marie, Pozzato Ilaria, Arora Mohit, Myles Daniel, Bourke John, Tran Yvonne, Cameron Ian D, Middleton James W, Craig Ashley
John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW, Australia.
Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Front Rehabil Sci. 2025 Apr 7;6:1537890. doi: 10.3389/fresc.2025.1537890. eCollection 2025.
Spinal cord injury (SCI) is a severe neurological disorder resulting in loss of movement and altered sensation with lifelong impacts on health, function, and social integration. Multidisciplinary SCI rehabilitation primarily focuses on enhancing function and independence while simultaneously managing secondary health conditions and providing psychosocial support. Therefore, a major goal in SCI rehabilitation should be strengthening patients' capacity to cope with and adjust to challenges they encounter. Using a mixed methods design, the primary aim of this study is to integrate psychosocial guidelines that promote psychological adjustment into SCI rehabilitation, and second, to evaluate facilitators and barriers to their successful implementation.
To determine perceived depth of knowledge, beliefs, and attitudes about psychosocial care, and usage of psychosocial guidelines, healthcare professionals in the three specialist SCI services in New South Wales, Australia will be invited to complete a baseline survey. Following the survey, semi-structured one-to-one interviews and focus groups will be conducted with healthcare professionals representing different health disciplines to understand the context and generate ideas about how best to integrate these guidelines into clinical practice. Based on the surveys, interviews, and focus groups, an implementation intervention employing educational strategies, structural, and nudge (behavioural change) approaches will be designed and implemented over a period of 18-months to facilitate integration of the guidelines into the SCI services. A post-intervention survey with healthcare workers will then be conducted. Focus groups from each SCI service, with representation across the different healthcare professions, will also be conducted to identify facilitators and barriers to implementing the guidelines. Success of implementation will be determined by analyzing any shifts in perceived knowledge, attitudes, and behaviour of staff and cultural/structural processes observed through comparing baseline and post-intervention qualitative and quantitative data. To capture lived experience insight, 10 patients with SCI currently undergoing rehabilitation will be interviewed.
This study will establish the success of implementing psychosocial guidelines into three specialist SCI services. It is hypothesized that constructive changes will occur in the knowledge, attitudes, and behaviour of the SCI Unit healthcare professionals, leading to improved psychosocial practices and patient outcomes that will strengthen person-centred healthcare in SCI rehabilitation. This study has been retrospectively registered with the Australian New Zealand Clinical Trials Registry on the 7th of May 2024. The registration number is: ACTRN12624000581561.
脊髓损伤（SCI）是一种严重的神经疾病，会导致运动丧失和感觉改变，对健康、功能及社会融入产生终身影响。多学科脊髓损伤康复主要侧重于增强功能和独立性，同时管理继发性健康状况并提供心理社会支持。因此，脊髓损伤康复的一个主要目标应是增强患者应对和适应所遇挑战的能力。本研究采用混合方法设计，主要目的一是将促进心理调适的心理社会指南纳入脊髓损伤康复，二是评估其成功实施的促进因素和障碍。
为确定对心理社会护理的认知深度、信念和态度以及心理社会指南的使用情况，将邀请澳大利亚新南威尔士州三家专业脊髓损伤服务机构的医疗保健专业人员完成一项基线调查。调查之后，将与代表不同健康学科的医疗保健专业人员进行半结构化一对一访谈和焦点小组讨论，以了解背景情况并就如何最好地将这些指南纳入临床实践提出想法。基于这些调查、访谈和焦点小组讨论，将在18个月的时间内设计并实施一项采用教育策略、结构和助推（行为改变）方法的实施干预措施，以促进指南融入脊髓损伤服务。然后将对医护人员进行干预后调查。还将组织来自每个脊髓损伤服务机构、涵盖不同医疗专业的焦点小组讨论，以确定实施指南的促进因素和障碍。通过比较基线和干预后的定性和定量数据来分析工作人员的认知、态度和行为的任何变化以及观察到的文化/结构过程，从而确定实施的成功与否。为获取实际经验见解，将对10名正在接受康复治疗的脊髓损伤患者进行访谈。
本研究将确定在三家专业脊髓损伤服务机构中实施心理社会指南的成功情况。据推测，脊髓损伤科医疗保健专业人员的知识、态度和行为将发生建设性变化，从而改善心理社会实践和患者预后，加强脊髓损伤康复中以患者为中心的医疗保健。本研究已于2024年5月7日在澳大利亚新西兰临床试验注册中心进行回顾性注册。注册号为：ACTRN12624000581561。
