Spinal cord injury community follow-up. Role of the physical therapist.

This study was conducted over a 14-month period to assess the physical therapy intervention needs of 201 patients who attended monthly spinal cord injury (SCI) outpatient clinics conducted in three outlying local communities of northern California. Methods to identify and provide appropriate physical therapy services for the patients were explored. An experienced physical therapist from a regional SCI center and other clinic staff members screened the patients and identified 66 patients (33%) who needed physical therapy services, including evaluation (82%), patient education (62%), and referrals to appropriate local health care professionals or equipment vendors (52%). Losses of joint range of motion, changes in sitting posture as a result of increased muscle tone or contracture, and malaligned or misfitting lower extremity orthoses were identified as problem areas not commonly recognized in routine follow-up examinations. Recommendations based on our study findings included the use of a screening form for physical therapy needs at each clinic, improved patient education about the role of the physical therapist as a resource person during follow-up care, coverage for each of the three clinics on a biannual basis, and continued study of the mechanisms used by other SCI centers to fulfill the outpatient needs of their patients. Physical therapy involvement in SCI follow-up services can maximize efficient use of our health care resources and provide early identification and management of specific postdischarge needs.