Scope & Purpose

Need for a Comprehensive Clinical Practice Guideline in SCI

Although there is a large and expanding body of clinical research directed toward improving patient care, thirty to forty percent of patients do not receive appropriate evidence-based care.1,2 As the volume of research evidence is rapidly increasing, it is challenging for healthcare professionals to remain informed on the latest research and related clinical recommendations across care domains.

Clinical Practice Guidelines (CPGs) are tools for improving health care and assisting health care professionals to make clinical decisions based on scientific evidence and expert opinions. The most important benefit of clinical practice guidelines is their potential to improve both the quality and consistency of care provided by healthcare professionals and resulting patient health outcomes. Their beneficial effects, however, are contingent on not only a methodologically rigorous guideline development process that incorporates the best evidence available, but also successful implementation of the resulting recommendations and associated tools.

Existing CPGs within SCI are focused on specific impairments (i.e. skin integrity, bowel management) or a single segment of the care continuum (i.e. prehospital care, MRI diagnosis, surgical intervention, community participation). Further, the current CPGs do not address all the important clinical questions which arise for individuals throughout an individual's care journey. Furthermore, few guidelines provide recommendations for all members of the interprofessional care team that are tailored to the individual's level of injury and severity of injury (i.e. American Spinal Injury Association Impairment Scale, AIS).

The Can-SCIP Guideline is the first comprehensive living guideline designed to provide evidence-based recommendations for adults 18 years and older with a SCI in all phases of care (from pre-hospital emergency care through acute and rehabilitation care and on to community care), across an individual's lifetime.

Guideline Target Audience

The Can-SCIP Guideline was developed to inform SCI care practices of healthcare professionals across a wide variety of settings.

The primary users for Section I: Components of the Ideal SCI Care System are policy makers and administrators.

The primary users for Section II: Management of SCI Complications are clinicians, allied healthcare providers, individuals with lived experience and their caregivers.

Guideline Target Population

The target population is for adults (i.e., 18 to 65 years old) who have sustained a traumatic spinal cord injury.

The majority of the identified recommendations were obtained from the traumatic SCI literature, acknowledging that some recommendations would only be applicable to the care of individuals with SCI of either traumatic or non-traumatic etiology, within the latter parts of the care continuum such as the rehabilitation and community care aspects of the guideline.

Limitations of Use

The content of these guidelines are based on the scientific knowledge available at the time of their finalization (2020) as well as on the opinion of the experts who participated in the development of the guidelines. Choices reflected in these guidelines do not preclude the possibility of other approaches or practices also being valid and relevant. Healthcare professionals must at all times use their clinical judgment and consider other factors such as patient preferences and resource availability in applying these recommendations. Moreover, healthcare professionals must at all times respect the legal and normative regulations of the regulatory bodies, in particular with regards to scopes of practice and restricted/protected activities, as these may differ provincially.

The developers, contributors and supporting partners shall not be liable for any damages, claims, liabilities, costs or obligations arising from the use or misuse of this material, including loss or damage arising from any claims made by a third party.

1Ketelaar M, Russell DJ, Gorter JW. The challenge of moving evidence-based measures into clinical practice: lessons in knowledge translation. Phys Occup Ther Pediatr. 2008;28(2):191–206.

2Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care. Lancet. 2003;362(9391):1225–30.