Evidence-based care for individuals with spinal cord injury: Role of the Clinical Practice Guidelines

Educating providers and consumers about best practices for the care of individuals with spinal cord injury is a global challenge that requires consistent and concerted efforts by dedicated professionals, as well as considerable resources. The scope of spinal cord injury care encompasses acute care for the newly injured, rehabilitative care to restore function, and care and support throughout the lifecycle. In addition to restoration of function and management of secondary medical complications, optimal clinical care addresses other important aspects of living with spinal cord injury, including preventive care and psychosocial issues.

For more than two decades, the drive to ensure that care after spinal cord injury is grounded in proven scientific methods has been spearheaded by the Paralyzed Veterans of America and the Consortium of Spinal Cord Medicine, which connects 23 organizations that share this collective mission. This partnership has produced a series of Clinical Practice Guidelines for Healthcare Providers and a companion series for consumers and caregivers, covering a range of important topics. Achieving the goal of uniform quality practice for all living with spinal cord injury requires the broadest possible dissemination, including the global reach of the Journal of Spinal Cord Medicine.

To augment the print distribution of the early Guidelines, they were published in issues of JSCM. Today, as new Guidelines and new editions become available, the Journal continues to devote resources to disseminating the Guidelines online and in print. In 2021, the three most recent Guidelines appeared in the Journal – a new one on Mental Health¹, an updated Guideline for managing neurogenic bowel dysfunction², and a substantial expansion of the original guideline on autonomic dysreflexia.³

Released in 2020, “Management of mental health disorders, substance use disorders, and suicide in adults with spinal cord injury,”¹ provides detailed guidance for detecting and treating mental health and substance abuse disorders across all settings. This timely Guideline helped meet the growing need for guidance as clinicians dealt with an increase in mental health problems fueled by pandemic-related anxiety, depression, and isolation. Dr. Charles Bombardier, panel chair for the development of this Guideline, reminds us that a Guideline is not an endpoint, but the start of a dynamic process:

No Clinical Practice Guideline provides final answers. May this Guideline point us toward a higher standard of care for now, eventually to be challenged, updated, and replaced with better information, more effective methods, and improved standards of care. This is what individuals with spinal cord injury deserve from us.

An update to a 1998 Guideline, “Management of neurogenic bowel dysfunction in adults after spinal cord injury”² released in 2020, reflects the evolution of our knowledge of the neurological influences on bowel function as a basis for a renewed perspective on reflexic and areflexic neurogenic bowel dysfunction. Panel chair Dr. Jeffery Johns emphasizes a holistic approach to managing bowel dysfunction that must be tailored to the needs of each individual.

The most recent Guideline is the third edition of a 1997 release on a topic that has accounted for more than 90% of PVA’s website traffic. The topic is autonomic dysreflexia, a sudden onset potentially life-threatening condition, presents major challenges to clinicians in emergency care who are unfamiliar with spinal cord injury. A panel co-chaired by Dr. Todd Linsenmeyer and Dr. Andrei Krassioukov adopted an expanded view of autonomic dysfunction after spinal cord injury in “Evaluating autonomic dysreflexia and other autonomic dysfunctions: Preventing the highs and lows.”³ Released in 2021, this Guideline recognizes a wider range of potential causes of autonomic dysreflexia, updates available treatments, and educates clinicians about the related conditions of orthostatic hypotension, hyperhidrosis, and thermodysregulation.

Recognizing the importance of Clinical Practice Guidelines to the care of all individuals with spinal cord injury, Taylor & Francis Publishing has provided full access to these timely documents, supporting their dissemination to the international community of spinal cord injury professionals.