Adapting international clinical practice guidelines for rehabilitation management of acute spinal cord injury in Iran

PURPOSE: This study aimed to adapt international clinical practice guidelines for the rehabilitation of acute spinal cord injury (SCI) in Iran. METHODS: This study was conducted based on guideline adaptation methods (the ADAPTE (ADaptation and eVALuation of a prE-existing guideline) framework). After an organizing committee was created and health topics selected, we searched PubMed, Scopus, and Cochrane Library from January 2011 to April 2021 to find guidelines regarding acute/subacute rehabilitation of SCI patients. The quality of the clinical practice guidelines was examined using the Appraisal of Clinical Guidelines for Research & Evaluation II. Recommendations were made by the committee and categorized according to population, intervention, professions, outcomes, and health care setting. The decision-making process was based on a systematic evaluation of each recommendation, utilizing a combination of quality for supporting evidence or against each recommendation, as well as consideration of feasibility, acceptance, and adoptability for the healthcare context of Iran. RESULTS: Our selection yielded 1 high-quality guideline containing 4 recommendations that underwent an adaptation process. Rehabilitation should be implemented as soon as patients are hemodynamically and neurologically stable and can tolerate the intensity. We suggest establishing specialized rehabilitation centers with trained personnel and proper equipment, providing tele-rehabilitation, education, and encouraging caregivers to help with early rehabilitation. Negotiating with insurance companies is imperative to cover the cost of long-term occupational therapy and rehabilitation. We suggest conventional over-ground training rather than treadmill training due to the lack of facilities. Individuals with acute/subacute cervical SCI should be offered functional electrical therapy. We find that additional training in unsupported sitting has no clear benefit associated with it when compared to the current standard rehabilitation. CONCLUSIONS: Implementation of international guidelines for SCIs and rehabilitation is a process that involves feasibility, acceptability, relevance, and adaptability when considering developing countries. The recommendations presented in this study have the potential to significantly improve the care provided to patients with SCI, not only in Iran but also could help guide developing countries in the healthcare arena.