Impact of the clinical practice guideline for preservation of upper limb function on transfer skills of persons with acute spinal cord injury

Laura A. Rice, Ian Smith, Annmaire R. Kelleher, Karen Greenwald, Claire Hoelmer, Michael L. Boninger

Research output: Contribution to journalArticlepeer-review


Objectives: To describe the development of a strict education protocol to implement the clinical practice guideline "Preservation of Upper Limb Function Following Spinal Cord Injury" into a clinical setting, and evaluate the effect of the protocol on transfer quality. Design: Randomized controlled trial. Setting: Acute Model Spinal Cord Injury Systems rehabilitation facility and community. Participants: Volunteer sample of full-time wheelchair users (N=70) with new spinal cord injuries randomized (1:1) to an intervention and standard-of-care group. Intervention: The intervention group was educated on transfer skills with a structured protocol implemented by a physical and occupational therapist who were extensively educated on the clinical practice guidelines and current transfer research. The standard-of-care group received standard therapy services. Main Outcome Measures: Comparison of transfer quality evaluated by the Transfer Assessment Instrument at 4 time points during first year after injury. Results: No significant differences were found between study groups. Secondary analysis based on type of transfer performed found that participants in the intervention group who performed assisted sitting pivot transfers performed higher-quality transfers (mean ± SE: 9.43±.55) compared with the standard-of-care group (mean ± SE: 7.81±.46) (P=.026) at 1 year after discharge. Also, participants who performed a dependent transfer had a higher average score across all 4 time points (mean ± SE: 9.14±.34) compared with the standard-of-care group (mean ± SE: 8.09±.29) (P=.019). Conclusions: For participants who perform assisted or dependent transfers, use of an evidenced-based, structured education program during acute inpatient rehabilitation has the potential to significantly improve the quality of transfers. Further follow-up testing is necessary with a larger sample size to determine the long-term effects.

Original languageEnglish (US)
Pages (from-to)1230-1246
Number of pages17
JournalArchives of Physical Medicine and Rehabilitation
Issue number7
StatePublished - Jul 2013


  • Medical education
  • Rehabilitation
  • Spinal cord injuries
  • Wheelchairs

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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