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McClure, Laura Ann (2010) IMPLEMENTATION OF CLINICAL PRACTICE GUIDELINES FOLLOWING ACUTE SPINAL CORD INJURY. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Individuals with spinal cord injuries who use a wheelchair for full time mobility are at high risk for developing upper limb pain and dysfunction, which can negatively impact functional mobility and quality of life. Due to the detrimental effects, the Consortium for Spinal Cord Medicine and the Paralyzed Veterans of America developed a clinical practice guideline (CPG) to educate clinicians on upper limb preservation methods. Past research has found that passive implementation of a CPG does not change clinical practice and a structured program is needed for effective education. In this dissertation, we have developed a strict protocol to implement the CPG and performed a randomized clinical trial to determine if new wheelchair users who were strictly educated on the CPG have better functional mobility skills, wheelchair characteristics and lower pain. During the course of the study, we found no objective method to evaluate the quality of a transfer. Therefore, an original outcome measure was developed. We evaluated the tool and found that it is safe, can be completed in a short amount of time and has a wide range of reliability and validity. Refinements are necessary, but the tool fills a substantial void in the area of transfer evaluation. The newly created outcome measure was used to evaluate the transfer skills of participants in the randomized trial. A trend in the data found that participants who were strictly educated on the CPG performed better transfers at six months post discharge. The same group of participants was evaluated on wheelchair set up, selection and manual wheelchair propulsion skills. No differences were found between groups based on wheelchair set up and selection; however those strictly educated on the CPG propelled with significantly lower normalized peak resultant forces at six months post discharge. Finally, results found that individuals who were strictly educated on the CPG reported higher pain during movement activities at six months post discharge, although this may be due to increased awareness. The new outcome measure and structured education program are important tools to improve care provided during acute rehabilitation for full time wheelchair users with spinal cord injuries.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
McClure, Laura Annlam88@pitt.eduLAM88
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBoninger, Michaelboninger@upmc.eduBONINGER
Committee MemberKoontz, Aliciaakoontz@pitt.eduAKOONTZ
Committee MemberKirby,
Committee MemberSchmeler, Markschmeler@pitt.eduSCHMELER
Committee MemberCooper, Roryrcooper@pitt.eduRCOOPER
Date: 19 August 2010
Date Type: Completion
Defense Date: 20 July 2010
Approval Date: 19 August 2010
Submission Date: 23 July 2010
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Clinical Practice Guidelines; Outcome Measure; Spinal Cord Injury; Transfers; Wheelchair Propulsion
Other ID:, etd-07232010-174605
Date Deposited: 10 Nov 2011 19:53
Last Modified: 19 Dec 2016 14:36


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