CONFERENCE POSTER ABSTRACTS 1–46 6TH National Spinal Cord Injury Conference: Bioinformatics Inform SCI Rehabilitation October 2–4, 2014 Allstream Centre, Toronto, Ontario Abstract ID: 1

IT’S NOT JUST ABOUT NEUROLOGY: IMPAIRMENT, MEDICAL COMPLEXITY, AND FUNCTIONAL ABILITY PREDICT REHABILITATION LENGTH OF STAY IN CANADA B. Catharine Craven1, Karen Ethans 2, Dany H. Gagnon 3, Angelo Gary Linassi4, Deborah Tsui 5, Andrea Townson 6, Carly Rivers 7, Jason Chen7, Vanessa Noonan 7 1

Toronto Rehabilitation Institute – UHN, 2University of Manitoba, 3University of Montreal, 4University of Saskatchewan, 5Hamilton Health Sciences, 6UBC Division of Physical Medicine and Rehabilitation, GF Strong Rehab Centre, 7Rick Hansen Institute Background/objective: Predicting clinical and economic variables that impact upon inpatient rehabilitation length of stay (LOS) is controversial, yet significantly influences resource allocation required for optimal outcomes. Our aim was to identify patient-related factors evident at admission to a spinal cord injury (SCI) rehabilitation unit likely to extend LOS. We sought to describe the impact of relevant demographic, impairment, and medical complexity variables at rehabilitation admission on rehabilitation LOS among adult Canadians with traumatic SCI admitted for inpatient rehabilitation. Methods/Overview: Data were obtained via chart abstraction from Rick Hansen SCI Registry sites. Variables included subject’s rehabilitation onset days, LOS, age at injury, sex, International Standards for Neurological Classification for Spinal Cord Injury (ISNCSCI) impairment (Neurological Level of Injury (NLI), ASIA Impairment Scale (AIS)), and medical complexity including prior ventilation (VENT), PEG tube (PEG) or indwelling bladder catheter (IBC) at acute discharge, Pain Interference Scale Score (PISS) > 15 and functional ability using ISNCSCI lower extremity motor scores (LEMS) ≤20/50 at rehabilitation admission. For univariate analyses, the dependent variable was LOS, with VENT, PEG, IBC, LEMS, and PISS as independent variables. Multivariate linear regression analyses used log LOS as the dependent variable with AIS, VENT, IBC, and LEMS as independent variables. Results: Adult men and women (n = 827, 82% male), mean (SD) age of 45 (18) years, with traumatic SCI AIS A–D; 255 (32%) high cervical C1–C4; 243(31%) low cervical C5–T1; 158 (20%) thoracic T2–T10; and 138 (17%) thoracolumbar T11–S5 were included. Median (lower quartile–upper quartile) rehabilitation onset days were 31 (18–54) days and median rehabilitation LOS 83 (53–122) days. Univariate analyses revealed increased rehabilitation LOS (days) for prior VENT (133 vs. 79), PEG (131 vs. 96), IBC (159 vs. 89), LEMS (111 vs. 62), and PISS (108 vs. 95). Multivariate analyses accounted for 22% of the variation in rehabilitation LOS (r = −0.2255, f 24.38, P < 0.001). Based on this multivariate model, the presence of all four variables (comparator level) AIS C–D, prior VENT, IBC, and LEMS ≤20 predicts a 180-day rehabilitation LOS versus, 40.3 days for absence of these variables. Conclusions: Impairment grades, specifically NLI and AIS alone, are insufficient predictors of rehabilitation LOS for patients with SCI. Use of direct rather than surrogate assessments of LOS predictors will likely result in improved accuracy of LOS predictions. LOS calculators must account for the patient’s medical complexity and functional abilities. Acknowledgements: Funding Source: Rick Hansen Institute

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© The Academy of Spinal Cord Injury Professionals, Inc. 2014 DOI 10.1179/2045772314Y.000000000250

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Abstract ID: 2

CREATION OF AN INTEGRATED PROCESS FOR GOAL SETTING, PATIENT EDUCATION, AND TRANSITION PLANNING IN SPINAL CORD REHABILITATION Heather Flett, Sandra Mills, Jennifer Holmes, Carol Scovil, Tess Devji, Kristina Guy Toronto Rehabilitation Institute – UHN Background/objective: To develop a new interprofessional rehabilitation process which integrates goal setting, patient education and transition planning and focuses on patients as partners. The specific goals of this initiative were to better engage patients in their care, enhance team communication and collaboration, and place patient and family securely within team processes. Methods/Overview: Toronto Rehablitation Institute’s Clinical Best Practice Process was used to systematically guide implementation. Patient’s need was identified through patient satisfaction results, retrospective chart audits, and staff and stakeholder feedback. A review of present practice critically examined current goal setting, patient education, and transition planning processes. Best practices were then determined through literature review, benchmarking, and environmental scan. A gap analysis compared present and best practices to identify key opportunities for improvement. During preparation for implementation, LEAN methodology was used during 2-week-long rapid improvement events to develop standard work processes and new clinical tools. Staff education materials and stakeholder engagement were also completed prior to implementation. A phased implementation approach was used whereby pilot testing of new forms and team processes was conducted followed by subsequent evaluation and staff feedback. Implementation involved a hospital wide roll-out of new processes. Results: Phase one implementation has been completed which involves a new process for care planning in which patients’ learning priorities across all domains of spinal cord injury (SCI) rehabilitation inform teaching and learning required during their rehab. New SCI domain-based team rounds forms which drive the “patient as partner” philosophy have also been implemented. Other deliverables include “It’s Teamwork” poster which describes interprofessional team roles in different domains of SCI and SCI domains patient orientation form. Seventy clinical staff have been trained to date. Pre-implementation surveys were completed by 20 patients and 36 staff. Post-implementation survey results will be presented. Conclusions: Preliminary findings suggest that an integrated, interprofessional process for goal setting, patient education, and transition planning enhances the overall patient experience in SCI rehabilitation and improves team communication. Patients have increased awareness of the scope of learning possible during and after rehabilitation. Acknowledgements: Brain and Spinal Cord Rehab Program, Toronto Rehab, UHN Grant Number: N/A

Abstract ID: 3

IMPLEMENTATION OF A PRESSURE ULCER PREVENTION EDUCATION BEST PRACTICE FOR PERSONS WITH SPINAL CORD INJURY. Stacey Guy1, Anna Kras-Dupuis 2, Dalton Wolfe 1,3 1

Lawson Health Research Institute, 2St. Joseph’s Healthcare, London, 3Western University

Background/objective: As part of SCI KMN nationwide effort to facilitate best practice within the area of spinal cord injury, an education practice to prevent pressure ulcers was implemented in an inpatient rehabilitation setting.

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Methods/overview: Based on network consensus regarding essential practice components, an inter-professional team of clinicians used implementation science principles to develop this practice with focus on self-management. Practice principles are based on standardized content, adult learning strategies, patient self-direction, reinforcement methods, and individualized education. Attention is focused on key drivers of implementation, including stakeholder engagement, improvement cycles, and on sustainability through robust, non-person-dependent processes. Descriptive analysis of patient evaluation surveys and healthcare provider process documentation was undertaken to examine practice adherence and to inform practice improvements. Results: Implemented in December 2012, this practice includes patient participation in a 30-minute interactive skin health session, receiving a resource kit and guidance to take ownership of daily skin checks. The team reinforces key prevention strategies throughout the patients’ daily activities. Over the 6 months of the initial practice implementation, 98% (N = 59) of patients received formalized education with kit within 2 weeks of admission. Seventy-three percent of these patients had documentation of structured education in their health record. This represents an opportunity for improvement. Inpatient feedback (N = 49) indicates 94% received and understood information about personalized skin-care and learned relevant skills, 92% felt that this educational information was presented in a way that satisfied their individual needs, and 90% reported that they would apply this knowledge in their everyday lives. As well, 89% reported that they would use learned skills in their daily life post-discharge. At follow-up (N = 12), 42% of the patients reported using the skills and information presented about skin care after they were discharged. Conclusions: An inter-professional, self-management focused practice has been instituted. Initial results suggest structured and individualized skin health education has been integrated into clinical practice with fidelity. Consistent, standardized, non-person dependent processes and regular adherence feedback to clinicians have been the key to sustainability of this practice. Acknowledgements: Ontario Neurotrauma Foundation Grant Number: 2010-ONF-BPI-833

Abstract ID: 4

INCORPORATING EVIDENCE-BASED PRACTICE INTO LIFE CARE PLANS THROUGH SCHOLARLY PRACTICE Stephanie Hadi1, B. Catharine Craven1,2 1

Toronto Rehabilitation Institute – UHN, 2Department of Medicine, University of Toronto

Background/objective: Spinal cord injury (SCI) disrupts sensory, physical, and autonomic function leading to secondary health condtions that significantly impact an individual’s quality of life. Life care plans (LCP) are medico-legal documents intended to ensure sufficient resources to support an individual’s evolving medical and rehabilitation needs as they age. LCP include “standard treatments” and rarely include “experimental” therapies or devices. Scholarly practitioners routinely critically appraise the SCI literature to determine which therapies and/or technologies are proven or promising for LCP inclusion. We sought to address the conundrum of critically appraising SCI relevant therapies and/or technologies prior to LCP incorporation; and, to describe products of this process for five specific therapies and technologies: functional electrical stimulation therapy (FES-T), locomotor training, transanal irrigation, hydrophilic coated catheters and intravesicular botulinum toxin. Methods/overview: A targeted literature search was conducted using Ovid MEDLINE® for each of the five investigated therapies and technologies. Studies were reviewed to determine patient outcomes and were then classified using SCIRE Project’s “Methods of Systematic Review: Five Levels of Evidence” (www.scireproject.com). Information about resources (personnel and costs) were extrapolated from the literature, company websites and personal communication with experts in the field. The level of research evidence, anticipated expenditures, frequency, and intensity of five specific therapies and technologies are reported and their potential or proven efficacy was rated for LCP inclusion. Results: FES-T (levels 1a and 2) requires a minimum of 40 treatment sessions and costs ∼$5000 to access ($1000 for electrodes, and $4000 for therapist salary). Intravesicular botulinum toxin (level 1a) requires 30

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intramuscular injections (1 ml) and costs $400/vial (10 ml). Transanal irrigation (level 1a) costs approximately $4050/annum total, and $320/month for supplies. Hydrophillic coated catheters (levels 1 and 2) costs ∼$150 for 30 catheters/box. Locomotor training (levels 4 and 5) has shown potential in improving balance, walking speed, and community ambulation, and requires 200 Toronto Rehabilitation Institute – UHN 220 sessions and costs $150 Toronto Rehabilitation Institute - UHN170/session. Conclusions: There is merit in allocating funds in LCP for innovative therapies and technologies that have either proven or have shown promising results in augmenting function and/or ameliorating multimorbidity following SCI. Acknowledgements: Support from the Toronto Rehabilitation Institute – University Health Network

Abstract ID: 5

ADAPTING EXERCISE EQUIPMENT WITH COMMON FASTENERS IMPROVES ACCESSIBILITY Judy Lugar 1,2 1

Neurorehabilitation Program, Nova Scotia Rehabilitation Centre, QEII Health Sciences Centre, 2Physiotherapy Dynamics Background/objective: Medical grade and specialty exercise equipment are very expensive and often designed to be used with assistance. Independent use of many modalities is restricted by the availability of assistance and can be a limiting factor for primary users. Snowboard bindings are strong, commonly available and easy to modify. Industry standard click straps are designed to be used with gloved or mittened hands. These straps are used in adaptations in many sporting applications. This specialized equipment can make independent exercise possible for people with impaired grasp function. Methods/overview: An aging stim cycle’s leg-securing system required assistance for positioning and securing the 12 original velcro fasteners. These awkward fasteners prevented independent use by the owner. We replaced the foot-positioning system with snowboard bindings and all velcro fasteners with click straps. Results: Adaptations permitted independent use and prevented purchase of a more modern and very expensive device. Conclusions: Well-designed common equipment can be utilized to improve accessibility and independent use of specialized exercise equipment. Warrantee limitiations and safety considerations must be considered. Exercise equipment accessibility modifications can be inexpensive, safe, and achieved with common tools. Acknowledgements: Self funded

Abstract ID: 6

FRAGILITY FRACTURES AFTER SPINAL CORD INJURY: INSIGHTS FROM THE BONE QUALITY IN INDIVIDUALS WITH CHRONIC SCI STUDY Cheryl Lynch 1,2, Lora Giangregorio 1,2, Rick Adachi 1,2, Neil McCartney 3, Alexandra Papaioannou 4, Milos Popovic 2,5, Lehana Thabane 4, B. Catharine Craven 2,5 1

University of Waterloo, 2Toronto Rehabilitation Institute – UHN, 3Brock University, 4McMaster University, University of Toronto

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Background/objective: Sublesional osteoporosis (SLOP) is common after spinal cord injury (SCI). Wide confidence intervals exist for fragility fracture prevalence and incidence (50–75%) after SCI. Lower extremity

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(LE) fracture care best practice is conservative management of below knee fractures and operative management of above knee fractures. This abstract describes the incidence, prevalence, and management of LE fragility fractures in a cohort of Ontarians with chronic SCI. Methods/overview: Adults (age >18 years) with chronic SCI (C2–T12, ASIA Impairment Scale (AIS) A–D of >2 years duration) consented to prospective BMD monitoring and LE fracture surveillance. Participants with bisphosphonate exposure were not excluded, but those with secondary osteoporosis were excluded. Participants attended site visits every 6 months for 24 months for medical, fracture, and serious adverse event screening and bone density assessment. Fracture surveillance included quarterly telephone screening and incident fracture verification by X-ray or chart review. Descriptive statistics were used to report fracture management, prevalence, and incidence at baseline and during follow-up. Results: Data were collected from 70 participants (50 men) of mean age 49 ± 12 years and SCI duration 16 ± 10 years. Impairment distribution was 33% paraplegia AIS A–B, 31% tetraplegia AIS A–B, 17% paraplegia AIS C–D, and 19% tetraplegia AIS C–D. Many participants (33%) reported prevalent fragility fractures at baseline, most of whom were motor complete (87%). During follow-up, 18 (15 LE) fragility fractures occurred. Most participants who fractured were motor complete (93%) and current bisphosphonate users (67%). A minority reported SLOP diagnosis after fracture (39%). Transfers (39%), followed by low-velocity falls from sitting height (28%), were the most frequent causes of fracture. Half of participants with incident fractures reported ER visits, and 36% reported requiring in-patient care (median LOS 7 days, range 3–29 days). Reported fracture care included casting (36%), splinting (22%), surgery (21%), or no stabilization (21%). Conclusions: The study cohort reported a high prevalence and incidence of LE fragility fractures. The incident fracture rate was highest for motor complete participants, many of whom (66%) were bisphosphonate users. The discordance between the incidence of LE fragility fracture and reported SLOP diagnosis is striking, and represents a gap in SLOP health services. The spectrum of reported fracture care was consistent with current best practices. Acknowledgements: The authors acknowledge the support of the Ontario Neurotrauma Foundation (#2009-SCIMA-684), the Canadian Institutes of Health Research (#86521), and the Spinal Cord Injury Solutions Network (RHI) (#2010-43). Toronto Rehabilitation Institute – UHN receives funding from the Ontario Ministry of Health and Long-Term Care. The views expressed herein do not necessarily reflect those of the funders.

Abstract ID: 7

THE LONG-TERM CLINICAL BENEFITS OF PARTICIPATING IN RESEARCH: A LONG-TERM FOLLOW-UP, CASE STUDY OF A PARTICIPANT AND SEVERAL CLINICIANS’ INVOLVEMENT IN “FEASIBILITY OF AN INTERNET CLINIC FOR TREATING AND PREVENTING PRESSURE ULCERS”? Brenda MacAlpine Stan Cassidy Centre for Rehabilitation Background/objective: The Stan Cassidy Centre for Rehabilitation was a site in The Feasibility of an Internet Clinic for Treating and Preventing Pressure Ulcers, a multi-site pilot study to assess the feasibility of integrating several information technologies, each deployed over the internet within the practices associated with clinical management and prevention of pressure ulcers in persons with spinal cord injury (Wolfe et al., 2012). It was hoped that assessment, treatment, and prevention services could be delivered effectively over the internet and that they would be accepted by the clients and the clinicians involved. This case study examines the longer-term effects on one participant and the impact on the clinical practice for the clinicians. Methods/overview: At completion of the study, the client was invited to remain in contact with the study OT via email to assist with prevention of ulcers. This client was of particular concern as prior to the study he had not adopted an active role in the monitoring of his skin health, and was unsure how to manage problems. Approximately 6 months post-discharge from services, he contacted the study OT via email including a picture of reddened area he developed since restarting basketball. The OT referred to the seating clinic. The information sent via internet prior enabled the clinicians to be prepared such that solutions could be presented

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in first visit. Several months after this he emailed the study OT with concerns regarding new symptoms to find his needs are medically derived and he has been referred onto his physiatrist. Results: The client was empowered to contact a central source and ask for help on how to prevent pressure ulcers. The personal and healthcare costs of a pressure ulcer were avoided. Since the completion of the study, community clinicians have continued to consult the study OT and RN regarding clients with wounds. There is now discussion regarding a more formal internet clinic. Conclusions: The costs of treating ulcers are a staggering burden to the healthcare system. Access to specialized services can be limited especially for rural clients or those restricted to bed rest as part of their treatment. Studies have shown that extended travel may exacerbate ulcers (Matheson et al. 2000). An internet clinic makes clinical and fiscal sense. Studies with a primary focus on increasing access and efficiency for the client should be explored by clinicians. The impact long term can be profound. Acknowledgements: No funding for case study.

Abstract ID: 8

THE SWING SLING Dianna Mah-Jones Vancouver Coastal Health-G.F Strong Rehabilitation Centre Background/objective: Independence in transfers is a common goal in spinal cord rehabilitation. The sliding technique, with or without a board, is used when individuals do not have the capacity to weight-bear through the legs to move from Point A to Point B. The procedure requires the client to lean forward to off-load weight from the buttocks, then to push through the arms to shift the body upwards and laterally. Momentum for the manoeuvre is amplified when the head and upper body turn in the opposite direction of the hips. Challenges with transfers occur in the acute rehabilitation phase as well as with chronic spinal cord injury due to client factors such as strength, balance, pain, size, and confidence. Poorly performed transfers can result in pressure wounds and shoulder strains. From a staff perspective, transfers requiring moderate-to-maximum assistance increase the risk of musculo-skeletal injuries. The swing sling technique was developed to facilitate functional training with at-risk clients and to provide an alternative approach to self-managed transfers. Methods/overview: A canvas transfer sling was modified with vertical straps to attach to the arms of the overhead mechanical lift. The client’s upper thighs and buttocks are centred on the sling, and one or both vertical straps run behind the shoulders to reduce the risk of the client falling backwards. An anterior chest strap serves as a light restraint and a kinesthetic cue for the flexed position. The client is raised to a height commensurate to his/her arm strength to shift the body between surfaces. As the client becomes stronger, less fearful, and more skilled in the sliding procedure, the sling is weaned off. Results: Three case examples are provided of the swing sling being used as an interim step in learning sliding board transfers and of being the method of choice for use at home by both a newly injured client and client with chronic spinal cord injury. Conclusions: The swing sling transfer enables a graduated approach to transfer training and allows persons with weight, arm or skin issues to perform transfers safely on their own. The sling design positions the client in an active sitting posture and the arms are free to push, pull and reach. With the mechanical assist, staff can start sliding transfer training earlier and with minimal burden in terms of effort and manpower. The swing sling transfer is appropriate for newly injured clients and for those with a chronic injury. Acknowledgements: NA

Abstract ID: 9

PERINATAL CARE FOR WOMEN WITH SPINAL CORD INJURIES Kate McBride 1, Lynsey Hamilton 2, Melanie Basso3, Stacy Elliott 4,5, Shea Hocaloski 4, Karen Hodge, Vanessa Noonan 2

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GF Strong Rehabilitation Centre, 2Rick Hansen Institute, 3BC Women’s Hospital and Health Centre, 4Blusson Spinal Cord Centre, 5Vancouver Coastal Health Background/objective: To determine gaps in the provision of perinatal care to women with spinal cord injury (SCI). Methods/overview: Content experts and stakeholders from across Canada were identified and invited to participate in a one-day workshop held in Vancouver, BC (November 2013). An online pre-workshop survey was sent to 30 participants to elicit anonymously their opinions related to the needs of women with SCI at each stage of perinatal care. Nineteen responses were received, representing clinicians, researchers, and consumers. Four team members individually reviewed the results for thematic content then met to compare emerging concepts. Resulting themes were summarized and presented to the 25 workshop participants who further analyzed and distilled the survey findings through group processes and consensus building conducted on the day of the workshop. Results: Three central themes emerged from the survey data: knowledge, access and collaboration. Participants determined that the first step in improving perinatal care for women with SCI is to use the findings from this project to create a “roadmap” outlining the key areas of need at each stage of perinatal care for women with SCI. Conclusions: This study sparked connections and call to action within the SCI/rehab/OBS community. The proposed roadmap will inform clinical care, research, education, policy change, and social reform via collaborations between clinicians, researchers, and consumers. Acknowledgements: Granting Agency/Funding Source: Rick Hansen Institute Grant number: NA.

Abstract ID: 10

MINIMIZING ERRORS IN TRAUMATIC SPINAL CORD INJURY CLINICAL TRIALS BY ACKNOWLEDGING THE HETEROGENEITY OF SPINAL CORD ANATOMY AND INJURY SEVERITY: AN OBSERVATIONAL CANADIAN COHORT ANALYSIS Vanessa Noonan 1,2, Marcel F Dvorak 1,2, Nader Fallah 1,2, Charles G Fisher2, Carly S Rivers1, Henry Ahn 3,4, Eve C Tsai 5,6,7, A Gary Linassi 8, Sean D Christie 9, Najmedden Attabib 9,10,11, RJohn Hurlbert 12, Daryl R Fourney13, Michael G Johnson14, Michael G Fehlings 4, Brian Drew15,16, Christopher S Bailey17, Jerome Paquet 18,19, Stefan Parent20,21,22, Andrea Townson 2, Chester Ho 12, B. Catharine Craven4,23, Dany Gagnon 22, Deborah Tsui 24, Richard Fox25, Jean-Marc Mac-Thiong 20,21, Brian K Kwon2, RHSCIR Network 1

Rick Hansen Institute, 2University of British Columbia, 3St. Michael’s Hospital, 4University of Toronto, 5The Ottawa Hospital, 6Ottawa Hospital Research Institute, 7University of Ottawa, 8University of Saskatchewan, 9 Dalhousie University, 10Horizon Health Network, 11Saint John Regional Hospital, 12University of Calgary, 13 University of Saskatchewan, 14University of Manitoba, 15Hamilton General, 16McMaster University, 17Western University, 18Hôpital Enfant-Jésus, 19Laval University, 20Hôpital du Sacré-Coeur de Montréal, 21Hôpital Ste-Justine, 22 Université de Montréal, 23Toronto Rehabilitation Institute – UHN, 24Hamilton Health Sciences, 25Royal Alexandra Hospital Background/objective: Clinical trials of therapies for acute traumatic spinal cord injury (tSCI) have failed to convincingly demonstrate efficacy in improving neurologic function. Failing to acknowledge the heterogeneity of these injuries and under-appreciating the impact of the most important baseline prognostic variables likely contributes to this translational failure. Our hypothesis was that neurological level and severity of initial injury (measured by ASIA Impairment Scale, AIS) act jointly and are the major determinants of motor recovery. Our

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objective was to quantify the influence of these variables, when considered together on early motor score recovery following acute tSCI. Methods/overview: Eight hundred and thirty-six participants from the Rick Hansen Spinal Cord Injury Registry were analyzed for motor score improvement from baseline to follow-up. Results: In AIS A, B, and C patients, cervical and thoracic injuries displayed significantly different motor score recovery. AIS A patients with thoracic (T2–T10) and thoracolumbar (T11–L2) injuries had significantly different motor improvement. High (C1–C4) and low (C5–T1) cervical injuries demonstrated differences in upper extremity motor recovery in AIS B, C, and D. A hypothetical clinical trial example demonstrated the benefits of stratifying on neurological level and severity of injury. Conclusions: Clinically meaningful motor score recovery is predictably related to the neurological level of injury and the severity of the baseline neurological impairment. Stratifying clinical trial cohorts using a joint distribution of these two variables will enhance a study’s chance of identifying a true treatment effect and minimize the risk of misattributed treatment effects. Clinical studies should stratify participants based on these factors and record the number of participants and their mean baseline motor scores for each category of this joint distribution as part of the reporting of participant characteristics. Improved clinical trial design is a high priority as new therapies and interventions for tSCI emerge. Acknowledgements: Rick Hansen Institute, Health Canada

Abstract ID: 11

CURRENT TREATMENT OF INDIVIDUALS WITH TRAUMATIC SPINAL CORD INJURY: DO WE NEED AGE-SPECIFIC GUIDELINES? Vanessa Noonan 1,2, Henry Ahn 3,4, Christopher S Bailey5, Sean D Christie 6, Neil Duggal7, Michael G Fehlings 8, Joel Finkelstein 8,9, Daryl R Fourney10, R John Hurlbert 11, Brian K Kwon2, Andrea Townson 2, Eve C Tsai 12, Najmedden Attabib 6,13, Jason Chen 1, Marcel Dvorak2,14, Vanessa K Noonan 1,2, Carly S Rivers1, RHSCIRNetwork 1

Rick Hansen Institute, 2University of British Columbia, 3St. Michael’s Hospital, 4University of Toronto, 5Western University, 6Dalhousie University, 7London Health Sciences Centre, 8University of Toronto, 9Sunnybrook Health Sciences Centre, 10University of Saskatchewan, 11University of Calgary, 12The Ottawa Hospital, 13 Horizon Health Network, 14Vancouver General Hospital Background/objective: The elderly are increasingly at risk for traumatic spinal cord injury (tSCI) from falls compared with younger patients. However, it is unknown if this translates into different management and outcomes. Our objective was to determine whether age affected management decisions and outcomes. Methods/overview: tSCI patients with complete records prospectively recruited from 2004 to 2013 for the Rick Hansen Spinal Cord Injury Registry were included. Demographic/injury differences between age groups (1 year completed SCI community health survey online or via telephone. The survey intent was to provide a comprehensive assessment of the health and social service needs, participation, and quality of life of the Canadian SCI population, including comorbidity incidence in the prior year, among them fracture. The survey included demographic information and four identified risk factors for fracture: injury duration ≥10 years, age at injury

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