• Areas of Concern heading
  • Areas of concern Autonomic Dystrifexlia Link
  • Areas of concern Neurogenic Bladder link
  • Areas of concern Neurogenic Bowel link
  • Areas of concern Pressure Ulser link
  • Areas of concern Respiratory complications link
  • Health promotion and maintenance link
  • resources link


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Process for content development

The content on this site was compiled from Clinical Practice Guidelines, the Spinal Cord Injury Rehabilitation Evidence (SCIRE) website, and other extant reviews. Content was drafted initially by a Family Physician, a Physiatrist, and an Advanced Practice Nurse in Wound, Ostomy, and Rehabilitation. The content then went under a peer review process by a team of Family Physicians and Physiatrists to ensure the content was both relevant for Family Physicians and reflected the most up-to-date recommendations and best practices.

Levels of evidence

The levels of evidence presented for the recommendations are from SCIRE. For an overview, see Determining Levels of Evidence and Formulating Conclusions. The five levels of evidence used are as follows:

Level Research Design Description
Level 1 Randomized controlled trial (RCT) Randomized controlled trial, PEDro score Includes within subjects comparison with randomized conditions and cross-over designs
Level 2 RCT Randomized controlled trial, PEDro score < 6
Prospective controlled trial Prospective controlled trial (not randomized)
Cohort Prospective longitudinal study using at least 2 similar groups with one exposed to a particular condition
Level 3 Case control A retrospective study comparing conditions, including historical controls
Level 4 Pre-post A prospective trial with a baseline measure, intervention, and a post-test using a single group of subjects
Post-test A prospective post-test with two or more groups (intervention followed by post-test and no re-test or baseline measurement) using a single group of subjects
Case series A retrospective study usually collecting variables from a chart review
Level 5 Observational Study using cross-sectional analysis to interpret relations
Clinical consensus Expert opinion without explicit critical appraisal, or based on physiology, biomechanics or "first principles"


This eLearning resource uses the the following conventions:

Example Definition and Behaviour
External link A solid underline represents a link to an external website.
Internal link A dashed underline represents a link within this eLearning resource.



Additional information

A dotted underline indicates additional information can be retrieved by hovering your mouse over or touching the underlined text.
Hovering your mouse over or touching the symbol will reveal the evidence for the recommendation provided.
Hovering your mouse over or touching the symbol will reveal  additional information.


Advisory Committee

  • Colla J. MacDonald, EdD, Faculty of Education, University of Ottawa
  • Larry Chambers, PhD, FACE, HonFFPH(UK), FCAHS, Bruyère Research Institute
  • Jeffrey W. Jutai, PhD, CPsych, Bruyère Research Institute and Interdisciplinary School of Health Sciences, University of Ottawa
  • Nathan Hauch, MA, Spinal Cord Injury Ontario
  • François Boucher, MD, CCFP, FCFP, Department of Family Medicine, University of Ottawa

Subject Matter Experts

  • Marie-Josée Klett, MD, CCFP, Dip Sport Med, Department of Family Medicine, University of Ottawa
  • Lynne MacGregor, MD, The Ottawa Hospital
  • Toba Miller, RN, MScN, MHA, GNC(C), CETN(C), The Ottawa Hospital

Peer Reviewers

  • Terence Brennan, MD, Osgoode Village Health Centre
  • Christie Diekmeyer, MD, Department of Family Medicine, University of Ottawa
  • Hugh MacNeil, MD, Pinecrest-Queensway CHC
  • James Milligan, BSc, PT, MD, Director, Mobility Clinic, The Centre for Family Medicine Family Health Team, Kitchener, Ontario; Department of Family Medicine, McMaster University
  • Dana Pecjak, MD, The Ottawa Hospital
  • Vidya Sreenivasan, MD, The Ottawa Hospital
  • Gary Viner, MD, Department of Family Medicine, University of Ottawa

Instructional Designer


Medical Illustrator and Graphic Designer


  • Colla J. MacDonald, EdD, Faculty of Education, University of Ottawa


This project was funded in part by the Ontario Neurotrauma Foundation and the Rick Hansen Institute (2011-SCI-ELEARN-874).

The project was managed through the Bruyère Research Institute.