Table 2.
Percent of acute facilities by country income level meeting each indicator
| Indicators | HIC N = 13 |
LMIC N = 13 |
|---|---|---|
| Specialized care | ||
| Classify tSCI with neurological examination (p) | 77 | 62 |
| Have a team of clinical staff with SCI expertise (s) | 85 | 46 |
| Have a multidisciplinary team (s) | 85 | 38 |
| Timeliness & transition | ||
| Have a triage protocol for direct admission (p) | 69 | 31 |
| Have a direct relationship between acute SCI unit and referring rehab centers (s) | 85 | 69 |
| Have rehab facilities in acute unit (s) | 92 | 54 |
| Have spine surgeon on-call 24 h (s) | 92 | 85 |
| Have 24 h access to MRI (s) | 100 | 62 |
| Provide SCI medical follow-up (p) | 100 | 92 |
| Have 24 h access to CT scanner (s) | 100 | 100 |
| Have 24 h access to operating room (s) | 100 | 100 |
| Provide early rehab in acute setting (p) | 100 | 100 |
| Patient-centeredness | ||
| Have a peer counsellor (s) | 54 | 23 |
| Have a psychologist (s) | 85 | 62 |
| Provide services for detection and treatment for mental health (p) | 100 | 62 |
| Capacity to advance evidence-based care | ||
| Make regular use of data to inform SCI care (p) | 54 | 46 |
| Practice of care standardized to recommendations/guidelines (p) | 69 | 38 |
Structure and process indicators are represented by (s) and (p), respectively. Italic represents “hard to meet” indicators. HIC High-income countries, LMIC Low- and middle-income countries, SCI Spinal cord injury, tSCI Traumatic SCI. All the indicators, except for those listed below, were a yes/no question
For “classifying tSCI with neurological examination”, it is considered as “yes” if responded using International Standards for Neurological Classification of SCI examination [17] or clinical definition (e.g., sensory-motor deficit)
For “have a multidisciplinary team”, it is considered as “yes” if indicated having all the following positions caring for patients with tSCI in acute: surgeon (spine, ortho- or neuro-), nurse (registered nurse, registered practice nurse, or licensed practice nurse), rehabilitation physician/ physiatrist, physiotherapist (PT), occupational therapist (OT), social worker or case manager, psychologist [18]; in rehabilitation: rehabilitation physician/physiatrist, PT, OT, nurses (registered nurse or licensed practice nurse), psychologist, speech-language pathologist, case manager/social worker [19]
For “provide services for detection and treatment for mental health”, it is considered as “yes” if indicated any of the following: monitor mental health/emotional wellbeing, provide education, screening with no assessment tool, screening with the use of standardized assessment tool, interview and diagnosis conducted by appropriate healthcare provider, intervention strategies, including medication, counselling/psychotherapy, exercise/activation, self-management, reassessment prior to discharge, train staff to recognize symptoms of depression, anxiety, post-traumatic stress disorder, etc
For “provide SCI medical/rehabilitation follow-up”, it is considered as “yes” if answered “regularly” or “as needed” to the question “do you provide SCI medical/rehabilitation-related follow-up services after discharge?”