Core Practice Principles: A Mixed Methods Approach to Determine What Drives the Use of Seated Trunk Control...

Area of Science:

• Rehabilitation Medicine
• Neurology
• Clinical Assessment

Background:

• Seated trunk control (STC) is vital for independence and rehabilitation outcomes in spinal cord injury (SCI) patients.
• Current practices for assessing STC post-SCI vary, impacting the consistency and effectiveness of rehabilitation strategies.
• Understanding the factors influencing the adoption of STC assessment tools is critical for improving clinical practice.

Purpose of the Study:

• To investigate current methods for assessing STC in SCI rehabilitation.
• To identify enablers and barriers to the uptake of STC assessment tools using the Theoretical Domain Framework (TDF) and Capability-Opportunity-Motivation for Behavior Change (COM-B) model.

Main Methods:

• An explanatory sequential mixed-methods design was employed, starting with a survey of assessment tools.
• Focus groups and interviews were conducted to triangulate survey data and explore factors influencing assessment tool adoption.
• Participants included US-based clinicians and researchers experienced in SCI rehabilitation at leading SCI institutions.

Main Results:

• Seventy-two percent of surveyed clinicians use STC assessments, with the Berg Balance Scale (BBS) being most common.
• Qualitative data identified the Function in Sitting Test for Spinal Cord Injury (FIST-SCI) and direct observation as key STC assessments.
• Barriers to STC assessment use include limited evidence, lack of standardized guidelines, and funding issues; facilitators include practitioner knowledge and perceived clinical relevance.

Conclusions:

• Trunk control assessment is recognized as essential in US SCI rehabilitation, but integration is hampered by systemic and evidence-based challenges.
• There is a need for co-developed guidelines and further research to validate STC assessments for monitoring progress, fall risk, and functional independence.
• Addressing identified barriers can enhance the consistent application of effective STC assessment tools in clinical practice.