Development of the Canadian Spinal Cord Injury Best Practice (Can-SCIP) Guideline: Methods and overview

Spinal cord injury (SCI) is a life-altering injury that leads to a complex constellation of changes in an individual’s sensory, motor, and autonomic function which is largely determined by the level and severity of cord impairment. Available SCI-specific clinical practice guidelines (CPG) address specific impairments, health conditions or a segment of the care continuum, however, fail to address all the important clinical questions arising throughout an individual’s care journey. To address this gap, an interprofessional panel of experts in SCI convened to develop the Canadian Spinal Cord Injury Best Practice (Can-SCIP) Guideline. This article provides an overview of the methods underpinning the Can-SCIP Guideline process. The Can-SCIP Guideline was developed using the Guidelines Adaptation Cycle. A comprehensive search for existing SCI-specific CPGs was conducted. The quality of eligible CPGs was evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. An expert panel (n = 52) convened, and groups of relevant experts met to review and recommend adoption or refinement of existing recommendations or develop new recommendations based on evidence from systematic reviews conducted by the Spinal Cord Injury Research Evidence (SCIRE) team. The expert panel voted to approve selected recommendations using an online survey tool. The Can-SCIP Guideline includes 585 total recommendations from 41 guidelines, 96 recommendations that pertain to the Components of the Ideal SCI Care System section, and 489 recommendations that pertain to the Management of Secondary Health Conditions section. Most recommendations (n = 281, 48%) were adopted from existing guidelines without revision, 215 (36.8%) recommendations were revised for application in a Canadian context, and 89 recommendations (15.2%) were created de novo. The Can-SCIP Guideline is the first living comprehensive guideline for adults with SCI in Canada across the care continuum.脊髓损伤（Spinal Cord Injury, SCI）是一种会显著改变患者人生轨迹的损伤，可导致个体感觉、运动及自主神经功能出现一系列复杂的功能改变，此类变化在很大程度上由脊髓损伤的节段与严重程度决定。现有针对脊髓损伤的临床实践指南（Clinical Practice Guideline, CPG）仅针对特定损伤、健康问题或照护路径的某一环节制定，但无法覆盖患者全照护旅程中出现的所有重要临床问题。为填补这一空白，脊髓损伤领域的跨专业专家小组齐聚一堂，制定了《加拿大脊髓损伤最佳实践（Can-SCIP）指南》。本文概述了支撑《加拿大脊髓损伤最佳实践指南》制定流程的方法学框架。本指南采用指南改编周期（Guidelines Adaptation Cycle）进行开发：研究团队全面检索了现有针对脊髓损伤的临床实践指南，并采用指南研究与评价工具II（Appraisal of Guidelines for Research and Evaluation II, AGREE II）对符合纳入标准的指南进行质量评价。本次研究组建了由52名专家组成的专家小组，分组召集相关领域专家开展评审工作，依据脊髓损伤研究证据（Spinal Cord Injury Research Evidence, SCIRE）团队开展的系统评价证据，对现有指南推荐意见予以采纳、修订，或制定全新的推荐意见。专家小组通过在线调研工具投票通过了选定的推荐意见。《加拿大脊髓损伤最佳实践指南》总计纳入来自41份指南的585条推荐意见，其中96条推荐意见隶属于《理想脊髓损伤照护体系组成》章节，489条推荐意见隶属于《继发性健康问题管理》章节。其中281条推荐意见（占比48%）直接从现有指南采纳且未作修订，215条（占比36.8%）推荐意见针对加拿大本土临床场景进行了适配修订，另有89条（占比15.2%）为全新制定的推荐意见。本指南是加拿大国内首个覆盖全照护路径、面向成人脊髓损伤患者的动态综合指南。