Developing evidence-based process maps for spinal cord injury rehabilitation

Study design: Longitudinal audit. Objectives: To develop evidence-based maps of rehabilitation for different lesion categories. Setting: Midlands, UK. Methods: Over a 5-year period data for all newly injured neurologically damaged patients aged 18 years or more were collected and analyzed (n = 280). Data were collected from a functional independence measure (the Needs Assessment Checklist), patient records (paper and electronic) and patient goal planning records. The patients were grouped into different lesion categories. Standard milestones that patients in a given category would be expected to reach in rehabilitation were identified using goals set at goal planning meetings. Time when patients reached these milestones and variation between patients around time in reaching these milestones were calculated. Results: Median times from onset to admission, onset to rehabilitation and length of rehabilitation are given. Pictorial representations of rehabilitation (rehabilitation maps) were produced, using goals identified, median times of achievement and variation. This paper provides examples of these maps from one particular group, T8-T12 Frankel A. Conclusion: Pathways of care can be used in a number of ways: to identify the need for service change; to audit service change; to provide evidence-based expectations for staff, patients and external parties; to look at variances affecting care; to make this service transparent; to provide figures for comparison with other philosophies of care; and to ensure consistency across the service. Spinal Cord (2010) 48, 122-127; doi: 10.1038/sc.2009.94; published online 18 August 2009