Development of the Canadian Spinal Cord Injury Best Practice (Can-SCIP) Guideline: Methods and overview

Abstract

Introduction

Spinal cord injury (SCI) is a life-altering injury that leads to a complex constellation of changes in an individual’s sensory, motor, and autonomic function which is largely determined by the level and severity of cord impairment. Available SCI-specific clinical practice guidelines (CPG) address specific impairments, health conditions or a segment of the care continuum, however, fail to address all the important clinical questions arising throughout an individual’s care journey. To address this gap, an interprofessional panel of experts in SCI convened to develop the Canadian Spinal Cord Injury Best Practice (Can-SCIP) Guideline. This article provides an overview of the methods underpinning the Can-SCIP Guideline process.

Methods

The Can-SCIP Guideline was developed using the Guidelines Adaptation Cycle. A comprehensive search for existing SCI-specific CPGs was conducted. The quality of eligible CPGs was evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. An expert panel (n = 52) convened, and groups of relevant experts met to review and recommend adoption or refinement of existing recommendations or develop new recommendations based on evidence from systematic reviews conducted by the Spinal Cord Injury Research Evidence (SCIRE) team. The expert panel voted to approve selected recommendations using an online survey tool.

Results

The Can-SCIP Guideline includes 585 total recommendations from 41 guidelines, 96 recommendations that pertain to the Components of the Ideal SCI Care System section, and 489 recommendations that pertain to the Management of Secondary Health Conditions section. Most recommendations (n = 281, 48%) were adopted from existing guidelines without revision, 215 (36.8%) recommendations were revised for application in a Canadian context, and 89 recommendations (15.2%) were created de novo.

Conclusion

The Can-SCIP Guideline is the first living comprehensive guideline for adults with SCI in Canada across the care continuum.

Keywords:

• Spinal cord injury
• Clinical practice guidelines
• Evidence-based practice
• Knowledge translation

Acknowledgements

We extend our particular gratitude to the entire expert panel for their expertise, dedication and support of the Can-SCIP Guideline: Andrea Townson, Andréanne Richard-Denis, Andrei Krassioukov, Blayne Welk, Brian Kwon, Christine Short, Christopher West, Colleen O'Connell, Daryl Forney, Deena Lala, Denise Hill, Graham Jones, Heather Flett, Jamie Milligan, Jeff Wilson, Joanne Smith, John Chernesky, John Cobb, John Shepherd, Karen Ethans, Katharina Kovacs Burns, Kristin Musselman, Kristine Cowley, Laurent Bouyer, Leanna Ritchie, Lise Bélanger, Louise Russo, Marie-Thérèse Laramée, Michael Fehlings, Milos Popovic, Pamela Houghton, Peter Athanasopoulos, Richard Fox, Sean Christie, Sera Nicosia, Shane McCullum, Shea Hocaloski, Sonja McVeigh, Stacy Elliot, Steve Casha, Sukhvinder Kalsi-Ryan, Susan Jaglal, Teren Clarke.

Disclaimer statements

Contributors None.

Funding This work was supported by the Praxis Spinal Cord Institute (former Rick Hansen Institute) [grant number G2019-11].

Declaration of interest Dr. B. Catharine Craven acknowledges support from the Toronto Rehab Foundation as the Toronto Rehabilitation Institute Chair in Spinal Cord Injury Rehabilitation, and receipt of consulting fees from the Praxis Spinal Cord Institute. Vanessa Noonan and Christiana Cheng are employees of the Praxis Spinal Cord Institute. Eleni Patsakos, Janice Eng, Matthew Querée, Chester Ho and Ailene Kua report no conflicts of interest. Dr. M. Bayley receives a stipend from UHN- Toronto Rehabilitation Institute for his role as Medical Director but has no other conflicts of interests.

Conflicts of interest Authors have no conflict of interests to declare.