목적 : 본 연구는 척수손상 환자 평가 및 중재에 대한 지침과 체계적 문헌고찰을 기반으로 작업치료사들을 위한 가이드라인을 개발하는 것을 목표로 한다.
연구방법 : 수용개작과 직접 개발방식을 적용하여, 핵심 질문과 가이드라인 개발 범위를 결정하고, 가이드 라인 검색을 수행하며, 선정된 가이드라인을 평가하고 권고를 선택한다. 해결되지 않은 임상 질문에 대 한 추가적인 권고사항을 개발하고, 가이드라인 초안을 완성하고, 전문가 그룹에 의한 평가를 수행하며, 최종 가이드라인을 완성한다.
결과 : 개발된 가이드라인은 평가영역에서 17개 항목, 중재영역에서 58개 항목으로 총 75가지 항목으로 구성되었다. 각 항목은 권고 강도(A~D)에 따라 평가되었으며, 권고 강도가 높게 나타난 항목은 35개이 다. 신체기능개선중재, 욕창관리중재, 상지보호 전략, 일상생활활동 등에서 권고 강도가 높게 나타났다.
결론 : 개발된 가이드라인은 작업치료사들에게 근거기반 치료적 접근과 직무 역할의 확립을 돕는 중요한 도구로서 활용될 수 있기를 기대한다.
Objective: This study aimed to develop guidelines for occupational therapists treating patients with spinal cord injury based on a systematic literature review of evaluation and intervention guidelines.
Methods: Using the adoption and direct development approach, the guideline development process involved 7 stages: determining the scope of key questions and guideline development, guideline search, selection, evaluation, and recommendation of identified guidelines, development of additional recommendations for unresolved clinical questions, completion of the guideline draft, expert group evaluation, and completion of the final guidelines.
Results: The developed guidelines consisted of a total of 75 items, including 17 items in the evaluation domain and 58 items in the intervention domain. In the evaluation domain, 5 items for functional assessment, 3 for pressure ulcer management, 3 for social participation, 2 for quality of life, 2 for pain management, 1 for discharge evaluation, and 1 for occupational balance were identified. In the intervention domain, 24 items for upper limb protection strategies, 8 for physical function improvement, 8 for activities of daily living, 7 for pressure ulcer management, 4 for respiratory management, 2 for rehabilitation timing, and 1 each for lifestyle, driving rehabilitation, vocational rehabilitation, leisure activities, and others were identified. Each item was assigned a recommendation level (A~D), and 35 items were rated as either A or B. Recommendations with high levels were found in the areas of physical function improvement intervention, pressure ulcer management intervention, upper limb protection strategies, and activities of daily living.
Conclusion: It is expected that the developed guidelines have helped occupational therapists treating patients with spinal cord injury establish evidence-based treatment approaches and clarify their professional roles.