A randomised controlled trial of a specialised multidisciplinary consultation team to improve the outcomes of patients with recent onset spinal cord injury in acute hospital

The intervention consists of a specialised multidisciplinary consultation team from the Spinal Rehabilitation Unit (SRU) at Caulfield Hospital (CH), Melbourne, Australia. The team will include a rehabilitation medicine doctor, physiotherapy and occupational therapy personnel with expertise in spinal cord injury (SCI) rehabilitation. The team will function as a mobile unit, assessing and reviewing SCI patients in acute hospitals. The physiotherapist and occupational therapist will see the patient for an initial focused assessment, jointly where practical. They will provide the patient and acute hospital treating team with patient-specific written and verbal advice, as relevant and appropriate, to optimise the patients’ care and outcomes. Self-care equipment and exercise equipment may also be provided to patients (with education on correct use) where indicated. The acute hospital nursing and allied health staff working with the patient will be engaged throughout the intervention process with the members of the specialised multidisciplinary consultation team. These efforts will be directed at trying to help improve patients’ independence and regain their ability to perform activities affected by their SCI, prevent SCI-related complications, and start specialist SCI rehabilitation strategies sooner than would otherwise be possible. It will be suggested that the recommendations made by the specialised multidisciplinary consultation team be incorporated into the patients existing program in the acute hospital. The patients’ status will be monitored and reviewed by a telephone call to the SCI patients treating acute hospital nursing or allied health team by at least one member of the specialised multidisciplinary consultation team within a week of initial assessment. All patients would have a direct medical review by one of the medical members of the team 7-10 days after the initial medical assessment and an allied health review (by either or both the physiotherapist and occupational therapist) within 7-10 days of the initial allied health review. Further direct reviews will occur 7-10 days after the second visit if clinically indicated and if the patient has not yet been admitted to the SRU. The duration of the intervention will be over the time after randomisation that the participant is in acute hospital, until admission to the SRU. It is not possible to state exactly what this duration will be, but it is anticipated that the expected duration will be about 1-6 weeks. For practical purposes, the study will limit inclusion to the 4 closest acute hospitals that refer the majority of SCI patients to the SRU at Caulfield Hospital, as listed above. The allied health members of the Consultation Team will all be qualified practitioners in their field and employed at Caulfield Hospital. Application for establishment of Honorary appointments will be made to the participating sites where consultation team members are not employed.