Developing and implementing evidence for the physiotherapy management of people with spinal cord injury

Abstract

This thesis contains five studies which contribute new evidence for the physiotherapy management of people with spinal cord injury (SCI) and its translation into practice. The study presented in Chapter Two used the benefit-harm trade-off method to determine the smallest worthwhile effect (SWE) of an intervention. The SWE is the smallest beneficial effect that justifies the effort, inconvenience, costs and potential harms of the person who is to receive the intervention. Defining a SWE is important for the interpretation of results of randomised controlled trials as it informs if an intervention is clinically worthwhile. This study describes the benefit-harm trade-off method as a valuable method to determine a SWE for a physiotherapy intervention.

The study in Chapter Three details the development of the recommendations for respiratory interventions from The Australian and New Zealand Clinical Practice Guidelines for the physiotherapy management of people with SCI (SCIPT CPG). Sixteen clinically important recommendations were made based on systematic reviews of the evidence using rigorous methodology, the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. These recommendations inform the respiratory management of people with SCI across the continuum of care and are accompanied with clinical rationale to support their uptake.

The studies in Chapter Four and Five of this thesis describe two qualitative studies that identified the barriers and facilitators to the implementation of the SCIPT CPG and a respiratory intervention (inspiratory muscle training, IMT). From these, implementation strategies were suggested to support the uptake of the SCIPT CPG and IMT, respectively. The strategies to support the use of IMT were tested in a pre-post study, presented in Chapter Six, and were shown to improve physiotherapists’ provision of IMT. Overall, the studies in this thesis contribute to improving physiotherapy management of people with SCI.