Integrating Spinal Cord Injury–Quality of Life instruments into rehabilitation: Implementation science to guide adoption of patient-reported outcome measures

Context/objective: This study describes a development strategy for integrating the Spinal Cord Injury–Quality of Life (SCI-QOL) item banks into inpatient spinal cord injury (SCI) rehabilitation and recommendations for protocol implementation. Design: We adopted an implementation science approach to develop a strategy for adapting and contextualizing SCI-QOL use during SCI rehabilitation. We conducted focus groups and stakeholder meetings with clinical assessment champions to (1) identify barriers and supports to SCI-QOL adoption; (2) reduce barriers and emphasize supports; (3) evaluate and select relevant SCI-QOL domains and item banks; (4) develop administration and reporting guidelines; and (5) identify hospital roles to alert with SCI-QOL results. Setting: A regional inpatient rehabilitation hospital. This study focuses on clinicians providing inpatient rehabilitation to patients with SCI. Participants: Fifty-nine clinicians, including physicians, speech language pathologists, occupational and physical therapists, nurses, and social workers providing care to SCI inpatients. Interventions: N/A. Outcome measures: N/A. Results: Clinicians identified the SCI-QOL domains that were most relevant to inpatient care; when SCI-QOL should be administered; what hospital roles were best suited for administering SCI-QOL; how results should be displayed in the electronic medical record; and which clinical roles needed notification of SCI-QOL results. Conclusions: Clinicians acknowledge the value of patient-reported outcome measures in inpatient SCI rehabilitation, but noted barriers to adoption. Engaging clinicians in the decision-making process for developing an implementation and administration protocol can inform strategies to overcome barriers and emphasize supports.