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Canadian SCI Rehabilitation Introduction

Identification of Data Elements Relevant to Primary Objective The review focused on providing an account of Canadian rehabilitation services and practices. Data elements were selected for their relevance to the rehabilitation goals and current practice. A substantial portion of the data was obtained from the web-based E-Scan survey. Patient utilization, availability and adequacy of staff resources, capital equipment and services were included in 3572 elements; and data regarding current clinical practice guidelines, care maps and publications (used to guide service delivery) were collected. Survey respondents were also asked to identify the clinicians and scientists likely to influence practice in the next five years. A letter of introduction regarding the survey process, a data element codebook, and survey guide were distributed to participating sites, prior to data collection. Survey administration was web based. Typical respondents were administrators and clinicians from the 13 participating sites. Data were stored in a central online repository. Data cleaning was done prior to analysis. Selection of Data Elements from Multiple Sources for Inclusion In order to provide a comprehensive account of current practice, against the backdrop of best available practice, the E-Scan investigative team examined a number and variety of sources. These sources included published systematic reviews (www.scireproject.com), clinical practice guidelines, clinical trial and cohort study registries, recent conference programs, relevant Canadian white papers, and grey literature for data elements relevant to the focus of the scoping review and the 17 rehabilitation goals. Coincidentally, many of the SCIRE systematic review chapter authors (who had recently completed extensive reviews of MEDLINE, CINAHL, etc.) were recruited to assist with data identification, using long-established search terms, and specific data quality assessments tools, including the Downs and Black checklist and PeDRO scoring systems (www.pedro.org.au). Descriptive Analysis of the Data Elements The data from the E-Scan survey were analyzed using SPSS (version 19), and initial national summary reports were produced using descriptive statistics. Collation, Summary and Results Data for each rehabilitation goal were produced in written form for an initial audit, and review by an E-Scan investigative team member. Conventional scoping review methods for summary and weighting of the data acquired were not used, as the volume, type and nature of the data varied widely across rehabilitation goals, rendering cross-chapter comparisons of data impractical. Rather, experts’ perception of the relevance of the data to practice was relied on, as the key filter. Consultation with Stakeholders Content experts, appropriate to the selected rehabilitation goals, were invited to participate in a series of WebEx teleconferences, regarding data interpretation and/or validation. Interprofessional working groups comprised at least five Canadian content experts per rehabilitation goal. Content review working groups then collated the summary findings (with information obtained from the aforementioned data sources, and their own expertise), and produced analytical interpretations of the information collected. Each rehabilitation goal includes a definition of the key construct or goal, descriptors of current service delivery (including staff, resources, practice patterns and outcome assessments, current key practice references and guidelines in use), and a list of Canadian content experts likely to influence practice in the next five years. Reviewers were asked to identify best practice organizations and indicators, and to highlight clinical, research and policy barriers to service delivery, through the data collation process, based on their own expertise and knowledge or new insights obtained from the discussions or data triangulation. Validation of the information obtained was received from practicing clinicians, across the country, via WebEx. Presentation of the Scoping Review Using a Formal Knowledge Transfer Strategy: Report Cards The conclusion of each chapter of the Atlas features a report card, to provide an overall rating of SCI rehabilitation service delivery, relative to three domains: • Knowledge generation • Clinical application • Policy change. Each report card category contains four operationally defined sub- elements, rated on a scale from insufficient to optimal (-5 to +5) and converted to a visual scale. At the bottom of each report card is a priority rating, ranging from one to three (1 to 3), with one indicating the category/domain of highest priority. Priority ratings identify where prospective efforts and funding must be directed, to achieve evolution in rehabilitation service delivery and practice.Specifically, sights are set on the year 2020, to achieve significant enhancement in best practice. Thus, the report cards serve as summaries for specific goals, as well as a means by which all rehabilitation goals, included in the Atlas, can be compared. Content and participating experts also provide a “take home message”, describing the steps required to revitalize the area of highest priority, between the time of the Atlas publication and 2020. E-SCAN SCOPING REVIEW METHODS 13


Canadian SCI Rehabilitation Introduction
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