The Journal of Spinal Cord Medicine

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/yscm20

Evidence-based care for individuals with spinal

cord injury: Role of the Clinical Practice Guidelines

Carolann Murphy & Florian P. Thomas

To cite this article: Carolann Murphy & Florian P. Thomas (2021) Evidence-based care for
individuals with spinal cord injury: Role of the Clinical Practice Guidelines, The Journal of Spinal
Cord Medicine, 44:4, 511-512, DOI: 10.1080/10790268.2021.1943291

To link to this article: https://doi.org/10.1080/10790268.2021.1943291

Published online: 16 Jul 2021.

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Editors’ Note
Evidence-based care for individuals with
spinal cord injury: Role of the Clinical Practice
Guidelines
Educating providers and consumers about best prac-
tices for the care of individuals with spinal cord injury
is a global challenge that requires consistent and con-
certed efforts by dedicated professionals, as well as con-
siderable resources. The scope of spinal cord injury care
encompasses acute care for the newly injured, rehabili-
tative care to restore function, and care and support
throughout the lifecycle. In addition to restoration of
function and management of secondary medical com-
plications, optimal clinical care addresses other impor-
tant aspects of living with spinal cord injury, including
preventive care and psychosocial issues.
For more than two decades, the drive to ensure that
care after spinal cord injury is grounded in proven
scientific methods has been spearheaded by the
Paralyzed Veterans of America and the Consortium
of Spinal Cord Medicine, which connects 23 organiz-
ations that share this collective mission. This partner-
ship has produced a series of Clinical Practice
Guidelines for Healthcare Providers and a companion
series for consumers and caregivers, covering a range
of important topics. Achieving the goal of uniform
quality practice for all living with spinal cord injury
requires the broadest possible dissemination, including
the global reach of the Journal of Spinal Cord
Medicine.
To augment the print distribution of the early
Guidelines, they were published in issues of JSCM.
Today, as new Guidelines and new editions become
available, the Journal continues to devote resources to
disseminating the Guidelines online and in print. In
2021, the three most recent Guidelines appeared in
the Journal – a new one on Mental Health1, an
updated Guideline for managing neurogenic bowel dys-
function2, and a substantial expansion of the original
guideline on autonomic dysreflexia.3
Released in 2020, “Management of mental health
disorders, substance use disorders, and suicide in
© The Academy of Spinal Cord Injury Professionals, Inc. 2021
DOI 10.1080/10790268.2021.1943291
adults with spinal cord injury,”1 provides detailed gui-
dance for detecting and treating mental health and sub-
stance abuse disorders across all settings. This timely
Guideline helped meet the growing need for guidance
as clinicians dealt with an increase in mental health pro-
blems fueled by pandemic-related anxiety, depression,
and isolation. Dr. Charles Bombardier, panel chair
for the development of this Guideline, reminds us that
a Guideline is not an endpoint, but the start of a
dynamic process:
No Clinical Practice Guideline provides final
answers. May this Guideline point us toward a
higher standard of care for now, eventually to be
challenged, updated, and replaced with better
information, more effective methods, and
improved standards of care. This is what individ-
uals with spinal cord injury deserve from us.
An update to a 1998 Guideline, “Management of neu-
rogenic bowel dysfunction in adults after spinal cord
injury”2 released in 2020, reflects the evolution of our
knowledge of the neurological influences on bowel
function as a basis for a renewed perspective on reflexic
and areflexic neurogenic bowel dysfunction. Panel chair
Dr. Jeffery Johns emphasizes a holistic approach to
managing bowel dysfunction that must be tailored to
the needs of each individual.
The most recent Guideline is the third edition of a
1997 release on a topic that has accounted for more
than 90% of PVA’s website traffic. The topic is auto-
nomic dysreflexia, a sudden onset potentially life-threa-
tening condition, presents major challenges to clinicians
in emergency care who are unfamiliar with spinal cord
injury. A panel co-chaired by Dr. Todd Linsenmeyer
and Dr. Andrei Krassioukov adopted an expanded
view of autonomic dysfunction after spinal cord
injury in “Evaluating autonomic dysreflexia and other
autonomic dysfunctions: Preventing the highs and
The Journal of Spinal Cord Medicine 2021 VOL. 44 NO. 4 511
Editorial
lows.”3 Released in 2021, this Guideline recognizes a
wider range of potential causes of autonomic dysre-
flexia, updates available treatments, and educates clini-
cians about the related conditions of orthostatic
hypotension, hyperhidrosis, and thermodysregulation.
Recognizing the importance of Clinical Practice
Guidelines to the care of all individuals with spinal
cord injury, Taylor & Francis Publishing has provided
full access to these timely documents, supporting their
dissemination to the international community of
spinal cord injury professionals.
ORCID
Carolann Murphy http://orcid.org/0000-0002-1030-
5903
Florian P. Thomas http://orcid.org/0000-0002-6103-
4138
512 The Journal of Spinal Cord Medicine 2021 VOL. 44 NO.
References
1 Bombardier CH, Azuero CB, Fann JR, Kautz DD, Scott Richards
JS, Sabharwhal S. Management of mental health disorders, sub-
stance use disorders, and suicide in adults with spinal cord injury.
Clinical Practice Guideline for Healthcare Providers. J Spinal
Cord Med. 2021;44(1):102–62. doi:10.1080/10790268.2021.
1863738.
2 Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M,
et al. Management of neurogenic bowel dysfunction in adults
after spinal cord injury. Clinical Practice Guideline for
Healthcare Providers. J Spinal Cord Med. 2021;44(3):442–510.
doi:10.1080/10790268.2021.1883385.
3 Krassioukov A, Linsenmeyer TA, Beck LA, Elliott S, Gorman P,
Kirshblum S, et al. Evaluation and management of autonomic dys-
reflexia and other autonomic dysfunctions: preventing the highs
and lows. Clinical Practice Guideline for Healthcare Providers. J
Spinal Cord Med. 2021;44(4):631–683.
Carolann Murphy
Assistant Editor
Florian P. Thomas
Editor-in-Chief
4