Mobility Clinic Team Composition: Optimizing Care for Individuals with Spinal Cord Injury

Specialized interprofessional primary care-based Mobility Clinics represent a significant opportunity to improve spinal cord injury (SCI) care, however, there are no gold standards to inform team composition. This study explored the ideal mix of skill sets and competencies for Mobility Clinics. METHODS Twelve individual interviews were conducted with primary care and rehabilitation clinicians and individuals from professional associations representing nurses, nurse practitioners, social workers, physical therapists, occupational therapists, physicians, physician assistants, and recreation therapists. Participants received briefing notes on the Mobility Clinic care model and roles of each discipline within this model. Questions were asked related to discipline specific scope of practice, ideal team composition to meet consumer needs, and opportunities for expanding and sharing discipline roles. RESULTS Discipline specific role descriptions within the Mobility Clinic were perceived to be comprehensive and accurate; in some cases additional activities were suggested for some disciplines. Suggestions were made for cross discipline sharing of tasks (e.g., some social worker activities can be assumed by occupational therapists, OT or nurse practitioners, NPs). Recommendations for core team members included a physician, nurse, OT, exercise therapist, and a representative from a SCI-specific community service, with linkages to specialists or interprofessional rehabilitation teams for consultation support. Potential roles were described for disciplines not currently represented in this care model (nurse practitioners, physiotherapists, physician assistants, recreation therapists). CONCLUSION As there exists a critical balance of optimizing care and availability of resources, this study informs appropriate Mobility Clinic team composition, adaptable within the context of existing human resources. Received: 09/11/2017 Accepted: 12/18/2017 © 2018 Milligan, et al. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. H IP & Mapping Collective Sensemaking in Communication ORIGINAL RESEARCH 3(3):eP1145 | 2 Introduction Mobility impairment is the inability to ambulate in a normal or usual manner, particularly without the use of an assistive device such as a cane, walker, or wheelchair and can be affected by neurologic conditions such as spinal cord injury (SCI), multiple sclerosis, and stroke, and musculo-skeletal conditions such as arthritis or general frailty. Although individuals with mobility impairments have similar basic health care needs as the general population, adults with physical disabilities are less likely to receive the same level of basic and preventative care (Iezzoni, McCarthy, Davis, & Siebens, 2000). They are at high risk for falls (Chang & Ganz, 2007) and experience decreased independence in activities of daily living (Hasegawa et al., 2008) and a variety of co-morbid health conditions such as depression, obesity, and diabetes (Chen, Divivo, & Jackson, 2005; Krassioukov, Furlan, & Fehlings, 2003; McDermott et al., 2005; Sharts-Hopko & Sullivan, 2003), plus significant secondary complications (e.g., pressure ulcers, spasticity, neurogenic bladder). Environmental barriers, such as the lack of wheelchair ramps, inadequate space for mobility aids or to transfer to an examination table and lack of appropriate equipment such as height-adjustable examination tables and grab bars, challenge access to health care for individuals with mobility impairments (Guilcher et al., 2010; Hwang et al., 2009). Other significant barriers include limited health professional knowledge of the care needs of individuals with mobility impairments (McColl et al., 2008) and health system disincentives for providing care to this patient population (DeJong, 1997; Marks & Teasell, 2009). As a consequence of these barriers many individuals with mobility impairments access emergency departments for primary health care (Guilcher et al., 2010). There is much support for improving access to care for individuals with mobility impairments through integrated care models that include community-based primary care and interprofessional care and that provide capacity building for health care professionals (Hwang et al., 2009; Mc-