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Black Box Unraveled

In 2009, the Phase One papers of the multi-site SCIRehab Project were published in the Journal of Spinal Cord Medicine. At that time, Whiteneck et al. stated that the Project's objective was ‘to open the “black box” of acute SCI rehabilitation, provide detailed information on treatments delivered by all rehabilitation disciplines, and contribute to outcomes-based guidelines for clinical decision-making.1’ Phase Two papers appeared in JSCM 2011, and the final Phase Three papers appear in this issue of JSCM. 
 
Unraveling the ‘black box’ of SCI rehabilitation was a major undertaking. The SCIRehab Project studied more than 1300 patients at six sites in the US. More than 1000 clinicians participated in the collection of detailed data on the individual interventions offered to patients with spinal cord injury during inpatient rehabilitation. Funded by the National Institute on Disability and Rehabilitation Research, the Project's investigators conducted comprehensive analyses of every component – nursing, physical, occupational and recreational therapy, speech-language pathology, psychology, and social work/case management. 
 
Each of the seven disciplines was defined and classified in Phase One; treatment times were analyzed for each for Phase Two. Phase Three – represented by the nine papers in this issue–looks at the associations between the interventions and patient outcomes at discharge and one-year post injury. These findings, which are based on practice-based evidence, are sure to provoke discussion and debate in the community of spinal cord injury professionals. 
 
JSCM is pleased to play a role in the dissemination of this ground-breaking series, which will inform study design clinical decision-making in SCI rehabilitation for years to come.