Marylou Guihan1,2, Kayla Roddick3,4, Tomas Cervinka5, Cara Ray1, Christopher Sutton6, Laura Carbone7,8, Frances M Weaver1,9. 1. Health Services Research and Development Service, Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines, Illinois, USA. 2. Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. 3. Department of Spinal Cord Injury, VA Boston Healthcare System, West Roxbury, Massachusetts, USA. 4. Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA. 5. Department of Physiotherapy and Rehabilitation, Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland. 6. Department of Orthopaedics, Medical College of Georgia at Augusta University, Augusta, Georgia, USA. 7. Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, USA. 8. Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia. USA. 9. Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, Illinois, USA.
Abstract
CONTEXT/ OBJECTIVE: The risk of lower extremity (LE) fractures in persons with spinal cord injury or disorders (SCI/D) is double that of the able-bodied population. LE fractures are the most common fracture location in SCI/D. Physical therapists (PTs) and occupational therapists (OTs) play an important role in rehabilitating LE fractures in Veterans with SCI/D. This paper describes their role in assisting persons with SCI/D and LE fractures to return to previous function and levels of participation. DESIGN: Cross-sectional semi-structured interviews were conducted by telephone. Setting: VA SCI centers. PARTICIPANTS: Purposive sample of therapists (PTs and OTs) experienced in LE fracture rehabilitation in SCI/D Interventions: NA. OUTCOME MEASURES: Coding of responses used a data-driven thematic and deductive approach, dictated by a semi-structured interview guide addressing the entire treatment process. RESULTS: Participants strongly advocated for early PT/OT involvement in post-fracture rehabilitation in order to recommend braces and devices to minimize skin breakdown, and needs for patient equipment, skills training and/or caregiver assistance resulting from post-fracture mobility changes. Seating specialists should be involved in post-fracture seating assessments in wheelchair users to address changes in alignment, deformities, limb length discrepancies and/or seating posture during and following fracture management. CONCLUSION: PTs and OTs are critical in rehabilitating LE fractures in persons with SCI/D and LE fractures, bringing expertise in patient function, ambulatory status, transfer strategies, mobility equipment, spasticity, lifestyle, and home and caregiver support. Involving them early in the rehabilitation process, along with orthopedic surgeons, physiatrists and other SCI clinicians can address the multiple and often unique issues that occur in managing fractures in this population.
CONTEXT/ OBJECTIVE: The risk of lower extremity (LE) fractures in persons with spinal cord injury or disorders (SCI/D) is double that of the able-bodied population. LE fractures are the most common fracture location in SCI/D. Physical therapists (PTs) and occupational therapists (OTs) play an important role in rehabilitating LE fractures in Veterans with SCI/D. This paper describes their role in assisting persons with SCI/D and LE fractures to return to previous function and levels of participation. DESIGN: Cross-sectional semi-structured interviews were conducted by telephone. Setting: VA SCI centers. PARTICIPANTS: Purposive sample of therapists (PTs and OTs) experienced in LE fracture rehabilitation in SCI/D Interventions: NA. OUTCOME MEASURES: Coding of responses used a data-driven thematic and deductive approach, dictated by a semi-structured interview guide addressing the entire treatment process. RESULTS: Participants strongly advocated for early PT/OT involvement in post-fracture rehabilitation in order to recommend braces and devices to minimize skin breakdown, and needs for patient equipment, skills training and/or caregiver assistance resulting from post-fracture mobility changes. Seating specialists should be involved in post-fracture seating assessments in wheelchair users to address changes in alignment, deformities, limb length discrepancies and/or seating posture during and following fracture management. CONCLUSION: PTs and OTs are critical in rehabilitating LE fractures in persons with SCI/D and LE fractures, bringing expertise in patient function, ambulatory status, transfer strategies, mobility equipment, spasticity, lifestyle, and home and caregiver support. Involving them early in the rehabilitation process, along with orthopedic surgeons, physiatrists and other SCI clinicians can address the multiple and often unique issues that occur in managing fractures in this population.
Authors: Laura D Carbone; Amy S Chin; Stephen P Burns; Jelena N Svircev; Helen Hoenig; Michael Heggeness; Lauren Bailey; Frances Weaver Journal: J Bone Miner Res Date: 2014-02 Impact factor: 6.741