| ObjectiveBased on the theory of neuroplasticity,this study,based on the group’s previous research,starts from the factors affecting the cognitive function of individuals with spinal cord injury,combines effective modular cognitive training methods,builds a comprehensive cognitive strengthening intervention model for individuals with spinal cord injury,and forms a systematic and complete cognitive function intervention model that can be easily grasped and operated clinically and applied to individuals with spinal cord injury.Methods1.Evidence summary: Using "spinal cord injury,spinal cord injuries,SCI,cognitive,cognition,cognitive impairment,cognition disorders,intervention" as search terms,computerized search of guidelines,expert consensus,clinical decisions,evidence summary and systematic evaluation in Chinese and English databases from the establishment of the database to January 2021,screening of literature and quality evaluation,analysis and summary of the best evidence of cognitive function intervention for individuals with spinal cord injury,and construction of a draft cognitive enhancement intervention model for individuals with spinal cord injury through group discussion.Draft integrated intervention model for individuals with spinal cord injury.2.Delphi expert consultation: Expert correspondence was implemented from January to February 2021,and 2 rounds of correspondence were conducted for this study.The questionnaires were sent by email and collected within 2 weeks after the experts’ confirmation.The experts evaluated the importance of the first,second,third and fourth level indicators and added or deleted indicators according to their own judgment.After the first round of questionnaire collection,members of the research team organized and analyzed the questionnaire,and the importance and feasibility of the assignment were ≥3.50,the coefficient of variation was <0.25,and the perfect score rate was >20% as the principle of indicator selection,combined with the experts’ opinions and suggestions,and the second round of expert consultation questionnaire was formed after collective discussion of the research team to revise and organize the indicators.In order to reduce the bias of memory influence,the second round of consultation started20 days after the first round of questionnaire collection.The second round of correspondence consultation was returned after 1 week.3.Pre-experiment: A small-sample non-randomized historical controlled study was used to recruit individuals with spinal cord injury attending the Department of Spinal Surgery in a tertiary care hospital in Anhui Province from November 2020 to January2021 into the control group,and individuals with spinal cord injury attending the hospital between March and September 2021 into the intervention group.The intervention group received cognitive reinforcement integrated intervention based on conventional rehabilitation instruction for spinal cord injury.The feasibility of the intervention model was evaluated using recruitment rate,dropout rate,compliance and satisfaction.Patients’ indicators were measured at the time of admission（pre-intervention）,1.5 months post-injury（during intervention）and 3 months post-injury（post-intervention）using the Changsha version of the Mo CA,SCIM Ⅲ,SER,HAMD and SSRS.A two-factor repeated measures ANOVA was used to evaluate the effectiveness of the intervention model and to revise the content of the intervention program in response to the problems that emerged during the intervention.Results1.Evidence summary: A total of 628 pieces of literature were retrieved,and 590 pieces of literature remained after removing duplicates.Excluding 577 literature that did not match the type of literature,topic,and target population,13 literature were finally included,including 4 guidelines,3 expert consensus,and 6 systematic evaluations.A total of 26 pieces of evidence were extracted,evaluated and summarized to form the best evidence of cognitive interventions for SCI patients,which formed 7 categories of indications,contraindications,intervention modalities,intervention duration,intervention intensity,precautions,and index monitoring.The draft intervention model was finally formed after group discussion,including 3 primary indicators,6 secondary indicators,26 tertiary indicators,and 70 quaternary indicators.2.Delphi expert consultation: There were two rounds of consultation.In the first round of consultation,16 questionnaires were distributed and 15 valid questionnaires were recovered,with an effective recovery rate of 93.8%,of which 9 experts put forward modification suggestions;In the second round,a total of 15 questionnaires were distributed,and 15 valid questionnaires were recovered,with an effective recovery rate of 100%.Among them,4 experts put forward modification suggestions,so 15 experts were finally included.The Kendall harmonization coefficients for the importance of the first,second,third,and fourth level indicators in the first round of expert consultation were 0.177-0.288,and the Kendall harmonization coefficients for feasibility were0.157-0.278,which were statistically significant（all P<0.001）.The Kendall harmonization coefficients for the importance of indicators of the 1st,2nd,3rd,and 4th levels of the 2nd round of expert consultation ranged from 0.135 to 0.200,and the Kendall harmonization coefficients for feasibility ranged from 0.129 to 0.233,which were statistically significant（all P<0.001）.The coefficient of variation for each indicator in the 2nd round of counseling ranged from 0.00 to 0.192,with a perfect score of 60.0% to 100.0%.The developed intervention model contained 4 primary indicators,10 secondary indicators,46 tertiary indicators,and 97 quaternary indicators.3.Pre-experiment: The control group included 20 patients and the intervention group included 18 patients.There was no significant difference between the two groups in general demographic data and effectiveness outcome indicators before intervention,which was comparable.The recruitment rate was 71.69% and the withdrawal rate was18.42%.At the end of the intervention,the patients’ satisfaction in the intervention group was higher than that in the control group（P < 0.05）.In addition to attention dimension and depression level,the total scores of cognitive function,visual spatial executive function,social support and spinal cord function independence in the intervention group were higher than those in the control group at each measurement time point（P < 0.05）.There was an interaction between the total scores of cognitive function,visual spatial executive function,attention dimension,depression level and social support in the two groups（P<0.05）,At the end of the intervention,the total scores of cognitive function,visual spatial executive function,attention,depression and social support in the intervention group were significantly higher than those in the control group（P<0.05）.ConclusionBased on the previous research of the research group,this study constructed a draft cognitive strengthening comprehensive intervention model for individuals with spinal cord injury by reviewing the literature and combining the clinical experience of the research group members.Finally,a comprehensive intervention model for cognitive strengthening of individuals with spinal cord injury was constructed for clinical use,The developed intervention model contained 4 primary indicators,10 secondary indicators,46 tertiary indicators,and 97 quaternary indicators,with certain scientific validity,feasibility and effectiveness.In the future,further clinical trials with large samples are needed to further evaluate the effectiveness of the intervention model and to delay the development of cognitive impairment,improve the quality of long-term rehabilitation and the rehabilitation outcome of individuals with spinal cord injury. |
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