Spinal Cord Injury Research Evidence

New research is coming out every day on best practices for spinal cord injury care and treatment. A clinician would have to read 20 journal articles a day, 365 days a year, to keep pace with current advances in health care knowledge. For people with spinal cord injury, there is a multitude of information available on the web, but it is not always clear what information is credible.

To overcome this challenge, RHI provided funding and support for the development of SCIRE (Spinal Cord Injury Research Evidence), a collaboration of Canadian and international SCI researchers that provides up-to-date, accurate information about spinal cord injury research.

SCIRE supports SCI health care providers in their practice by rating and reviewing current best evidence, covering a comprehensive set of topics relevant to SCI rehabilitation and community reintegration. It reviews, evaluates, and translates existing research knowledge into a clear and concise format to inform health professionals of best rehabilitation practices following SCI. Since the website launched in 2009, SCIRE has established itself as a popular and credible resource, receiving an average of 100,000 visitors a year.

In late 2017, SCIRE expanded to make this same research-based information available to the broader community by writing in everyday language, providing more background information and explaining the science behind the research. SCIRE Community covers a variety of topics such as common health issues for people with SCI, current treatments and contains an extensive video and resource library. SCIRE Community is funded by RHI through the Blusson Integrated Cures Partnership.

Visit SCIRE Professional at www.scireproject.com

Visit SCIRE Community at www.scireproject.com/community 

Our Projects & Initiatives

In this section you will find updates on many of our latest projects and initiatives including work in translational research and best practice implementation projects. These projects and initiatives directly support our main program objectives, with many supporting more than one program. 

Learn more about our projects and initiatives:

Data & Technology

RHI houses specialized teams in both data services and information technology in order to support projects across our network, providing an integrated approach to data- and technology-based solutions in SCI research and clinical care.

Here are a few examples of how RHI supports research and clinical care initiatives through technology and data services:

Global Research Platform (GRP) is a secure, web-based data collection and data warehousing platform that enables researchers to improve the quality of the data collected. Most notably, GRP is the technology behind the Rick Hansen SCI Registry which operates in Canada and has been piloted in New Zealand, Israel and China. In addition, GRP runs studies in Australia and the US.

ISNCSCI Algorithm is a free tool that helps clinicians accurately classify spinal cord injuries. The Algorithm is based on the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) – the most widely recognized assessment for determining a person's level of injury and impairment.

CliniQuick is a mobile electronic medical record (EMR) application designed to support real-time quality improvement in a clinical setting. Clinicians are able to enter patient information directly into a tablet or smart phone and review a summary of the treatment history and outcomes, eliminating the need to manually sort through stacks of cumbersome paper-based records.

We also provide data services for RHI-supported projects such as the Rick Hansen SCI Registry and Access to Care and Timing – from the point that data is entered into the GRP through to the point that it is analyzed for publications or summarized for reports.

The data team applies complex logic to make sense of the data, applying data and statistical analysis techniques so that researchers have the appropriate information they need to investigate a particular research question.

Other Projects & Initiatives

Below are a few more examples of translational research and best practice implementation activities that we are collaborating with other research organizations on.

Translational Research & Best Practice Implementation

In order to advance the objectives of our four core programs (Cure, Care, Commercialization and Consumer), RHI supports translational research and best practice implementation activities.

What is translational research?

Translational research is a branch of medical research that attempts to more directly connect research with patient care by turning basic discoveries (developed, for instance, through multi-centre research studies) into new treatments and approaches that tackle the most pressing needs of individuals with SCI.

RHI supports and undertakes translational research studies to generate knowledge about SCI and to seek ways to improve outcomes for people with the injury. These research projects are critical to the outcomes of RHI. The Rick Hansen SCI Registry (RHSCIR) supports our translational research activities by collecting core data from Canadians with SCI during their transition through acute care, rehabilitation and community integration, and throughout their life journey. This data will be available to all participating members to engage people in relevant translational activities, and help identify gaps and priority needs.

What is best practice implementation?

Best practice implementation is the interventions, programs/services, strategies, or policies which have demonstrated desired changes through the use of appropriate, well-documented research or evaluation methodologies. They have the ability to be replicated, and the potential to be adapted and transferred. A best practice is one that is most suitable given the available evidence and particular situation or context. 

The success of cure strategies will depend on changes in practice within the existing the health care delivery system. The time to implement best practices is currently 17 years. This needs to be dramatically shortened to ensure Canadians with SCI will benefit in their lifetime.

One of our goals is to become a world leader in promoting and implementing best practices for the care of people with SCI. Within our own clinical and research network, we are uniquely positioned to influence behaviour change, and ultimately move SCI research into action.

The overall aim of RHI’s best practice implementation projects is to lead the process of improving access to and adoption of knowledge, in order to help support evidence-based decision-making in SCI care in Canada and internationally.

Accreditation Standards

For individuals who sustain a spinal cord injury, the type of treatment and care they receive in the following days, weeks and months after their injury occurs are critical in determining their long-term outcomes. However, each hospital has its own set of protocols and it is not uncommon for care to vary depending on which hospital that individual is sent to. Creating a set of best practices specific to SCI that hospitals can work towards facilitates not only standardized care for individuals with a SCI, but optimized care as well.

Setting the bar - accreditation standards for SCI care

In 2012, RHI partnered with Accreditation Canada (AC), the preeminent healthcare accreditation body in Canada, to develop a set of comprehensive and evidence-based standards for spinal cord injury called the SCI Standards of Care (SCI Standards). These Standards are available for Acute and Rehabilitation Services and are part of AC's existing Qmentum accreditation program, which hospitals already participate in. The SCI Standards are the first set of accreditation standards designed specifically for spinal cord injury with a focus on improving quality of care through effective service design, use of best practices, enhancing staff competency, early intervention, preventing and monitoring secondary complications and early initiation of rehabilitation services. Hospitals with specialized SCI programs that opt to participate use the process to review their SCI programs against standards of excellence in order to improve patient outcomes and create efficiencies in the way care is provided. Accrediting hospitals and rehabilitation facilities with the SCI Standards help ensure that Canadians with SCI receive consistent, quality care no matter which hospital with specialized SCI programs they receive treatment at.

Standardization of care benefits not only patients, but also the health care system overall by reducing unintended variation in care that is not driven by evidence-based practice, thereby making more effective use of resources, improving patients' health outcomes, and reducing the burden on the healthcare system.

Interested in becoming an SCI-accredited hospital? Learn more about the process!

As a result of this collaboration and in coordination with the Rick Hansen SCI Registry, 13 hospitals and/or rehabilitation facilities with SCI programs have successfully implemented the SCI Standards to date, leading to enhanced and more consistent care for individuals who sustain a traumatic or non-traumatic SCI in Canada. For a complete list of accredited hospitals, see map below.

The next phase: taking an integrated, people-centered approach

The creation and implementation of the SCI Standards is a key achievement for RHI as we strive to optimize care for all individuals sustaining a SCI. To further enhance the standards and accreditation process, RHI partnered with the Health Standards Organization (HSO), an affiliate of AC, to embark on the next phase of accreditation. The new initiative will focus on:

1. Learning from accredited facilities, non-accredited facilities and other impacted stakeholders about the value of the accreditation standards to them; and
2. Identifying challenges and opportunities in order to enhance the accreditation process across all aspects of care (acute care, rehabilitation and community living).

By taking a people-centered approach, this initiative will engage people with lived experience of SCI, inviting individuals to act as partners and provide their experiences throughout their care journey from acute and rehabilitation care to living with SCI in the community. In gathering and analyzing this information, the next phase of the accreditation program will be better equipped to address the specific needs of the SCI community.

Supporting hospitals with their accreditation process

RHI continues to support hospitals in adopting the SCI Standards through the development of the Accreditation Toolkit. The toolkit includes an accessible library of resources that clinicians and policy makers can use to change practice (e.g. clinical practice guidelines, pre-printed orders), and frequently asked questions regarding the accreditation process.

→ Download the free Accreditation Toolkit!

Accredited hospitals

As of June 2019, 13 SCI centers that participate in the Rick Hansen SCI Registry have successfully fulfilled the SCI Standards. Congratulations to all involved, which demonstrates a real commitment to excellence in SCI care.