A system for documenting the details of the rehabilitation process

Disability and rehabilitation research has been hampered by the lack of a standard taxonomy for documenting and quantifying the many therapeutic interventions occurring during the multi-disciplinary rehabilitation process. The five-year multi-center SCIRehab Project is addressing this problem while identifying which of the many spinal cord injury (SCI) rehabilitation interventions are associated most strongly with positive outcomes at one year post-injury. Outcome measures include functional independence, medical complications, return to work or school, social integration, and quality of life. 1,500 consecutive initial SCI rehabilitation admissions of qualified and consenting individuals at six centers are being enrolled over 2.5 years.

Clinicians at six centers worked together in seven separate discipline-specific groups via two face-to-face meetings and weekly teleconferences for nine months to identify discipline-specific contributions to the SCI rehabilitation process and describe those activities. The resulting taxonomies (system of categorizing, coding, and quantifying interventions) for physical, occupational, recreational, and speech therapy, psychology, social work, and nursing capture details of rehabilitation activities not documented traditionally. Each SCI clinician at the six SCI centers has been entering information into handheld devices (into which each taxonomy is programmed) since October 2007.

Substantial variation in rehabilitation practice is found among the centers with two to five fold differences in the amount of time spent with individual disciplines and on specific interventional activities. The taxonomies and hand-held computer technology developed in this project offer the first practical method to document the details of the rehabilitation process that can be implemented across all disciplines in future disability research.