title: Impact of the clinical practice guideline for preservation of upper limb function on transfer skills of persons with acute spinal cord injury.
abstract: OBJECTIVE
  To describe the development of a strict education protocol to implement the clinical practice guideline "Preservation of Upper Limb Function Following Spinal Cord Injury" into a clinical setting, and evaluate the effect of the protocol on transfer quality.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Acute Model Spinal Cord Injury Systems rehabilitation facility and community.
  
  
  METHODS
  Volunteer sample of full-time wheelchair users (N=70) with new spinal cord injuries randomized (1:1) to an intervention and standard-of-care group.
  
  
  METHODS
  The intervention group was educated on transfer skills with a structured protocol implemented by a physical and occupational therapist who were extensively educated on the clinical practice guidelines and current transfer research. The standard-of-care group received standard therapy services.
  
  
  METHODS
  Comparison of transfer quality evaluated by the Transfer Assessment Instrument at 4 time points during first year after injury.
  
  
  RESULTS
  No significant differences were found between study groups. Secondary analysis based on type of transfer performed found that participants in the intervention group who performed assisted sitting pivot transfers performed higher-quality transfers (mean ± SE: 9.43±.55) compared with the standard-of-care group (mean ± SE: 7.81±.46) (P=.026) at 1 year after discharge. Also, participants who performed a dependent transfer had a higher average score across all 4 time points (mean ± SE: 9.14±.34) compared with the standard-of-care group (mean ± SE: 8.09±.29) (P=.019).
  
  
  CONCLUSIONS
  For participants who perform assisted or dependent transfers, use of an evidenced-based, structured education program during acute inpatient rehabilitation has the potential to significantly improve the quality of transfers. Further follow-up testing is necessary with a larger sample size to determine the long-term effects.
authors.affiliation: Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, IL, USA. ricela@illinois.edu
authors.forename: Laura A
authors.initials: LA
authors.lastname: Rice
authors.forename: Ian
authors.initials: I
authors.lastname: Smith
authors.forename: Annmaire R
authors.initials: AR
authors.lastname: Kelleher
authors.forename: Karen
authors.initials: K
authors.lastname: Greenwald
authors.forename: Claire
authors.initials: C
authors.lastname: Hoelmer
authors.forename: Michael L
authors.initials: ML
authors.lastname: Boninger
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease; D000328:Adult; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy; D026741:Physical Therapy Modalities; D017410:Practice Guidelines as Topic; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D034941:Upper Extremity; D014910:Wheelchairs