Expert Recommendations for a Clinical Guide Supporting the Use of Electrical Stimulation in Occupational Therapy Treatment of Spinal Cord Injury

Abstract

Abstract Importance: Clinical application of electrical stimulation (ES) to address functional deficits for those with spinal cord injury (SCI) is not consistent among occupational therapy practitioners, likely because of limited occupational therapy–specific clinical guidelines (OT–CG). Clinicians report the need for evidence-based guidance that supports their practice. Objective: To identify occupational therapy practitioners’ needs to support ES application in treatment sessions, utility of existing clinical practice guidelines for occupational therapy practitioners, challenges and opportunities to translate research findings into clinical practice, and desirable characteristics for an occupational therapy–specific ES clinical guide. Design: A panel of 7 senior occupational therapy clinicians with ES expertise was convened for two stages. In Stage 1, two focus group discussions were recorded, transcribed, analyzed, and thematically summarized. In Stage 2, panel members completed a member-check survey, and panelists reviewed a proposed outline for an OT–CG ES guide, rating the desirability of each section. Setting: Online expert panel. Participants: A purposive sample of occupational therapy clinicians eligible to administer ES, actively using ES with SCI, and employed at preeminent SCI centers. Results: An outline for an OT–CG to support consistent clinical use of ES among occupational therapy practitioners was developed. Three themes emerged: difficulty using clinical practice guidelines for electrical stimulation, lack of clinical examples to guide specific electrical stimulation treatment activities, and modifications to existing guidelines. Conclusions and Relevance: An outline for a proposed guideline was created; ideally, such a manual would improve treatment fidelity and predictable patient outcomes for those with SCI. What This Article Adds: A novel outline for an OT–CG was developed to provide treatment fidelity, structure to treatment approaches, and a basis for future scholarly study.