A validated framework to guide therapists in arm-hand rehabilitation for individuals with cervical spinal cord injury

Abstract

Objective

To develop and validate an evidence-based framework guiding therapists in arm-hand rehabilitation in individuals with cervical spinal cord injury, to enhance performance and activities of daily living.

Design

The framework was developed using a mixed-method approach: (1) item generation based on the UK Medical Research Council's guidelines for complex interventions; (2) four-round e-Delphi study with Likert scales and qualitative input; and (3) expert panel discussion.

Participants

The e-Delphi panel comprised 24 international rehabilitation professionals (16 occupational therapists and eight physiotherapists) with mostly ≥5 years of clinical and/or scientific experience in spinal cord injury rehabilitation. A separate expert panel included seven individuals with cervical spinal cord injury.

Main measures

e-Delphi consensus for each item was predefined as ≥70% agreement or inclusion across four rounds, with content analysis for qualitative input. Items were further discussed and validated during the expert panel and analyzed by content analysis.

Results

65 initially generated items were included in the e-Delphi; 36 were added from qualitative input; consensus was reached on 100 of the 101 items. The expert panel confirmed these items, added five, and reprioritized personal load capacity and motivation. The validated framework comprises three interrelated phases: (a) knowledge gathering—assessing personal needs, load capacity, and environment; (b) goal setting—collaboratively formulating person-centered, realistic goals; and (c) acting—a task- and goal-oriented training targeting meaningful activities and daily life integration. Motivation plays a key role across all phases.

Conclusions

This evidence-based framework provides guidance for therapists to deliver person-centered arm-hand rehabilitation tailored to patients’ needs.