Spinal cord injured persons’ conceptions of hospital care, rehabilitation, and a new life situation

Healthcare Experience of People with Acute Spinal Cord Injury: A Phenomenological Study

Living with spinal cord injury (SCI) is a challenge that begins in the acute phase, when the disease, the limitations, and the treatments fill the days at the hospital. This study aims to understand the healthcare experience of the person with SCI in the acute phase, based on the Activities of Living Nursing Model (ALNM). It is a qualitative and phenomenological study based on the Standards for Reporting Qualitative Research. Data were collected via semi-structured interviews. Content analysis was performed using the ATLAS.ti software and Bardin's methodology. The article was written following the COREQ guidelines. The categories were defined using the Roper-Logan-Tierney Model for Nursing. The sample included 16 people with incomplete SCI, different etiology, and neurological levels. Eleven of the twelve ALNM emerged from the interviews. The activities of mobilizing, eliminating, maintaining a safe environment, and communicating were emphasized the most. Controlling body temperature was not relevant. Mobility deficits and pain increased dependence. Feelings of motivation, encouragement, and frustration were highlighted. Professional expertise, rehabilitation resources, and support equipment promoted independence. The results in this sample revealed that people with SCI in the acute phase have complex challenges related to dependence awareness and treatments, but they always keep recovery expectations in mind.

Adult patient and carer experiences of planning for hospital discharge after a major trauma event: a qualitative systematic review

PURPOSE

To identify, evaluate and synthesize qualitative literature on adult patients and carer experiences of planning for discharge from an acute setting after a major trauma event.

METHODS

The JBI approach to meta-aggregation was followed. Qualitative studies exploring patient and carer discharge planning experiences of major trauma were included in the systematic review. A comprehensive search was conducted in five databases, supplemented by grey literature. Eligible studies were appraised for methodological quality by two reviewers and data extracted using standardized JBI tools.

RESULTS

Four synthesized findings emerged using 69 findings from sixteen papers. (i) Patients and carers feel generally unprepared to manage at home after discharge, (ii) early identification of patients' post discharge needs allows for appropriate referrals and supports to be organised prior to discharge, (iii) patients and carers value participation in the discharge planning process to facilitate a considered, organized and timely discharge from hospital (iv) the timely presentation, delivery, language used, format and relevancy of information impacts how patients and carers manage their discharge.

CONCLUSION

This meta-synthesis demonstrates that patients and carers predominantly have poor experiences of discharge planning after major trauma. Adoption of patient centered principles may improve patient and carer experiences of the discharge planning process.

IMPLICATIONS FOR REHABILITATIONPatients and their carers benefit from a client-centred approach where their needs are recognised and their collaboration encouraged in important decisions, and if they are adequately prepared to reintegrate into their community.Patients can benefit from having a trauma pathway healthcare professional to provide support and advocacy services throughout their hospital admission and after discharge.Discharge planning that is organised, prepared and collaborative leads to a more positive patient experience.Discharge information should be individualised and presented in an easily accessible format for patients and carers.

Influences on Participation in Life After Spinal Cord Injury: Qualitative Inquiry Reveals Interaction of Context and Moderators

Background

Greater understanding of the influences on participation in life after spinal cord injury (SCI) can inform rehabilitation theory and practice. Careful qualitative inquiry can reveal subjective meanings associated with the relevant experiences, strategies, and perceptions of those with lived experience of SCI. A search of literature, followed by a thematic synthesis of qualitative studies, was undertaken to bring together these insights in a meaningful way.

Methods

The research question guiding the literature review and synthesis was, What do people with SCI perceive to be the influences on their participation in life? Three critical databases were searched for qualitative studies examining influences on participation in life after SCI. Peer-reviewed studies published after 2006, involving adults with SCI living in countries with advanced economies, were included. Data were extracted from 24 articles and subjected to three-level thematic synthesis—the coding of primary data from the studies, the development of descriptive themes based on an organization of those codes, and the generation of analytical themes.

Results

The synthesis yielded five analytical themes, supported by 17 descriptive themes. The analytical themes were (1) external contextual influences, (2) personal physical context, (3) personal psychological context, (4) potential moderators of participation outcomes, and (5) temporal dimensions of participating in life after SCI.

Interpretation

These themes highlight the complex interactions that shape participation from the perspective of people with SCI. Closer examination of the potential moderators may provide insights into effective rehabilitation interventions.

Conclusions

Synthesis of qualitative inquiry provides valuable insights into the perceptions of influences on participation in life from the point of view of people with SCI. The findings of this synthesis are instructive for rehabilitation theory and practice. It can complement what we learn from using the ICF to understand participation.

Indicators of Quality of Care in Individuals With Traumatic Spinal Cord Injury: A Scoping Review

STUDY DESIGN

Scoping review.

OBJECTIVES

To identify a practical and reproducible approach to organize Quality of Care Indicators (QoCI) in individuals with traumatic spinal cord injury (TSCI).

METHODS

A comprehensive literature review was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL) (Date: May 2018), MEDLINE (1946 to May 2018), and EMBASE (1974 to May 2018). Two independent reviewers screened 6092 records and included 262 full texts, among which 60 studies were included for qualitative analysis. We included studies, with no language restriction, containing at least 1 quality of care indicator for individuals with traumatic spinal cord injury. Each potential indicator was evaluated in an online, focused group discussion to define its categorization (healthcare system structure, medical process, and individuals with Traumatic Spinal Cord Injury related outcomes), definition, survey options, and scale.

RESULTS

A total of 87 indicators were identified from 60 studies screened using our eligibility criteria. We defined each indicator. Out of 87 indicators, 37 appraised the healthcare system structure, 30 evaluated medical processes, and 20 included individuals with TSCI related outcomes. The healthcare system structure included the impact of the cost of hospitalization and rehabilitation, as well as staff and patient perception of treatment. The medical processes included targeting physical activities for improvement of health-related outcomes and complications. Changes in motor score, functional independence, and readmission rates were reported as individuals with TSCI-related outcomes indicators.

CONCLUSION

Indicators of quality of care in the management of individuals with TSCI are important for health policy strategists to standardize healthcare assessment, for clinicians to improve care, and for data collection efforts including registries.

Learning self-care skills after spinal cord injury: a qualitative study

BACKGROUND

People with a recent spinal cord injury (SCI) often follow intensive rehabilitation. Learning appropriate self-care, deal with their impairments and prevent secondary health conditions (SHCs), is highly important during rehabilitation. To date it is not clear how self-care skills are taught to people with SCI. The objective of this study was to understand how people with SCI experienced the learning of appropriate self-care skills during inpatient rehabilitation, including the role of the rehabilitation team.

METHODS

Individual semi-structured interviews were conducted with 15 people with SCI, recently discharged from initial inpatient rehabilitation. Interviews were audio-taped, transcribed and analyzed thematically.

RESULTS

Two main themes and seven sub-themes were identified. Participants stated that the contribution of the rehabilitation team to learning self-care, including prevention of SHCs, was mostly made by optimizing opportunities to learn through experience. For preventing SHCs, education and lessons learned from the professionals during therapy and the formal educational program, was experienced as especially important. Further, the motivational attitude of the professionals which participants found stimulating and was based on respect, combined with their positive contribution as one team, were seen as essentials elements for learning appropriate self-care. However participants did not recognize the contribution of the nursing staff as part of their rehabilitation, although it was seen as very important. An important aspect of the participants' own contribution was challenging oneself to learn self-care. This was done in different ways by the participants. Further, their own mental adjustment was considered important in the learning process. The gaining of confidence was by most participants seen as personal characteristic, although they also recognized the importance of the team effort and the experiences they underwent.

CONCLUSIONS

Learning appropriate self-care was mostly done through experience, by challenging themselves, and making use of the opportunities given by the members of the rehabilitation team. The same strategies used by the rehabilitation team to teach people with SCI to perform appropriate self-care, were also helpful for the participants to gain confidence. Explicit attention for self-care training as an important goal in SCI rehabilitation may strengthen the nursing staff's role and stimulate interdisciplinary working.

Patient perspective: diagnosis and prognosis of acute spinal cord injuries

STUDY DESIGN

Qualitative study.

OBJECTIVES

The purpose of this study is to understand the patient perspective after diagnosis of an acute traumatic spinal cord injury (tSCI). Discussing the diagnosis and prognosis of a tSCI with a patient can be a challenging experience for both the patient and the physician. As such, this paper attempts to better understand the patient experience to improve communication when discussing this life-altering injury.

SETTING

Vancouver General Hospital, Vancouver, British Columbia, Canada.

METHODS

This study is a qualitative study utilizing grounded theory and semi-structured interviews. The interview transcripts were manually coded using manifest and latent content analysis. Major and minor codes were identified and discussed.

RESULTS

In total, 17 interviews were conducted, fifteen individuals with tSCI who received acute care at Vancouver General Hospital (VGH) and eleven family members were interviewed. Patient participants were interviewed individually or in a paired interview with a participating family member. Patient participants had varying spinal cord injuries from AIS A-D. Two major themes were identified from the interviews. The first major theme was physician demeanor (general approach and attitude towards patients) and the second major theme was delivery of information (content, timing, and source).

CONCLUSIONS

This study summarizes the preferences of patients who sustained a tSCI discussions regarding their diagnosis and prognosis in the acute care setting. The goal of this study is to help guide physician interactions at this difficult and vulnerable time for patients with hopes to improve patient care through effective communication.

Predictors of Self-Efficacy Among People With Spinal Cord Injury During Inpatient Rehabilitation: A Cross-Sectional Study

PURPOSE

This study aimed to investigate the predictors of self-efficacy among Chinese people with spinal cord injury (SCI).

DESIGN

A cross-sectional, descriptive, correlational design was adopted.

METHODS

121 participants were recruited from two rehabilitation hospitals in Shaanxi, China, from August 2016 to June 2017. The Moorong Self-Efficacy Scale was used to assess participants' self-efficacy levels. Participants' sociodemographic or clinical characteristics, functional independence, coping ability (measured using the Brief Coping Orientations to Problems Experienced Inventory), and social support (measured using the Six-item Social Support Questionnaire) were assessed as potential predictors of self-efficacy. A multiple linear regression model was conducted to identify the factors predicting self-efficacy score.

RESULTS

The mean age of the participants was 41 (SD 11.9) years and 90% were male. Participants' mean self-efficacy score was 53.9 (SD 15.7). Multiple linear regression results indicated that injury type (i.e., paraplegia or tetraplegia; β = 0.290, p < .001) and adaptive coping (β = 0.561, p < .001) were significant predictors, accounting for 62% of the variance in self-efficacy scores.

CONCLUSIONS

Our findings imply that psychosocial interventions that target enhancing various adaptive coping strategies could have positive effects on self-efficacy in people with SCI.

CLINICAL RELEVANCE

Injury type and adaptive coping ability are two key factors related to patients' self-efficacy post-SCI. Psychosocial interventions that target enhancing various adaptive coping strategies could have positive effects on self-efficacy in people with SCI.

Access to community support workers during hospital admission for people with spinal cord injury: a pilot study

STUDY DESIGN

A descriptive qualitative study.

OBJECTIVES

To evaluate a pilot project enabling people with spinal cord injury (SCI) to have their support workers accompany them into a non-SCI specialist/public hospital (excluding ICU) to perform selected care.

SETTING

The study was conducted in New Zealand.

METHODS

Interviews and focus groups with people with SCI, support workers, care agency staff, and hospital staff who participated in the pilot project.

RESULTS

Twenty-five individuals participated in the study. Two themes captured participants' experiences of the pilot: 'Maintaining individualised care' and 'Role, tasks and responsibilities. Support workers were described as knowledgeable about SCI care needs and being better positioned to provide individualised care for people with SCI than general nursing staff. Participants with SCI felt less anxious having a support worker with them, and perceived less risk of acquiring secondary health complications during the hospital admission. Good communications is important to ensure there is a shared understanding of the role and responsibilities of having an unregistered support worker in the hospital environment.

CONCLUSIONS

Having their regular support worker during admission to public hospital improved the SCI-specific care received. Support workers reduced the demand on hospital nursing staff who did not always have the time or specialist SCI knowledge to provide individualised care. People with SCI may be more likely to access medical assistance earlier and not defer hospital admissions if they can have support workers accompany them into hospital.

Exercising Choice and Control: A Qualitative Meta-synthesis of Perspectives of People With a Spinal Cord Injury

OBJECTIVE

To systematically search the literature and construct a meta-synthesis of how choice and control are perceived by people with spinal cord injury (SCI).

DATA SOURCES

Medline, Academic Search Premier, CINAHL, Cochrane, EMBASE, HealthSource, ProQuest, PsychInfo, SAGE, and SCOPUS were searched from 1980 until September 2018 including all languages. Reference lists of selected studies were also reviewed.

STUDY SELECTION

Eligible qualitative studies included perspectives about choice of control as reported by people with an SCI. Studies were excluded if they included perspectives from other stakeholder groups. A total of 6706 studies were screened for title and abstract and full text of 127 studies were reviewed resulting in a final selection of 29.

DATA EXTRACTION

Characteristics of the studies were extracted along with any data (author interpretations and quotes) relating to perspectives on choice and control.

DATA SYNTHESIS

First-order analysis involved coding the data in each study and second-order analysis involved translating each segment of coded data into broader categories with third-order analysis condensing categories to 2 broad overarching themes. These themes were experiencing vulnerability or security and adapting to bounded abilities.

CONCLUSIONS

Perspectives of choice and control are influenced by interrelated environmental, interpersonal, and personal contexts. From a personal perspective, participants reported a readiness for adaptation that included turning points where emotional and cognitive capacity to make choices and take control changed. Health professionals need to be responsive to this readiness, promote empowerment and foster, rather than remove, hope.

Revealed by degrees: Patients' experience of receiving information after in-hospital cardiac arrest

AIMS AND OBJECTIVES

To describe patients' experience of receiving information about the event after having a cardiac arrest in hospital.

BACKGROUND

In Sweden, approximately 2,600 people per year experience cardiac arrest in hospital. After a cardiac arrest, the patient is entitled to receive information about what has occurred. This information must be provided in a way that does not do the patient more harm than good. In order to provide information to patients in a satisfactory manner for them, knowledge about how patients react to information in this situation is valuable.

DESIGN

We used a qualitative approach with interviews and content analysis.

METHODS

Twenty patients participated in face-to-face interviews analysed by content analysis. Consolidated criteria for reporting qualitative studies were used.

RESULTS

The analysis resulted in three categories: Getting the information gradually, Understanding information received and Seeking clarity. The subcategories that emerged were as follows: Indirect information, Short and direct information, Explanatory information, Lack of information, Unsatisfactory information, Hard-to-understand information, Insight, Unanswered questions, Hard-to-formulate questions, Requesting information and Searching independently for knowledge.

CONCLUSIONS

The patients needed gradual and repeated information during their hospitalisation, and repeated information was continually required after their discharge from hospital. Whether or how the information was given varied. The patients' experience was that they sometimes lacked opportunities for conversation and asking questions, while they also found it hard to formulate questions. Patients who have a cardiac arrest in hospital appear to have similar information needs to patients whose cardiac arrest takes place outside the hospital context.

RELEVANCE TO CLINICAL PRACTICE

Information on the patient's cardiac arrest should be given in gradual stages, according to the patient's needs. The information needs to be repeated during the hospital stay and after discharge. Healthcare professional should gain insight into patients' responses and create information that is adapted to the individual.

Relationships and the transition from spinal units to community for people with a first spinal cord injury: A New Zealand qualitative study

BACKGROUND

Spinal Cord Injury (SCI) can have substantial consequences for the injured person, and also their family/whānau (Māori word for extended family and social networks). Family members can adopt either formal or informal care roles when the person returns home, and people with high-level care requirements may also need non-family support workers.

OBJECTIVE

This study considers how SCI can impact relationships during the transition from spinal rehabilitation units to home.

METHOD

Nineteen SCI participants from the New Zealand longitudinal study were interviewed six months post-discharge from either of New Zealand's two spinal units. Data were analysed using the framework method.

RESULTS

Three themes captured participants' relationship experiences during the time of transition: Role Disruption, examines how participants' pre-SCI family/whānau relationships underwent change as previously understood parameters of engagement were disrupted. A Balancing Act, explores the challenge of renegotiating previously-understood parameters between participants and whānau. The Stranger in My/Our Room focuses on how the relationship between participants and support workers was (necessarily) new to the participant and their family/whānau who now had an 'outsider' episodically or continuously in their home. The specifics of 'their' relationship was also new to the support worker; and negotiating the parameters of this relationship could only occur on transition home.

CONCLUSION

SCI necessitates a renegotiation of relationships and, for some, also involves the negotiation of a new type of relationship with support workers. Understanding the ways a SCI may affect relationships can enable rehabilitation services to best support people with SCI and their family to prepare for their transition home.

Experiences With Navigating and Managing Information in the Community Following Spinal Cord Injury

Background: People living with spinal cord injury (SCI) have reported difficulties managing information in the community, which can negatively impact their functional independence and ability to prevent secondary complications. Objective: This exploratory qualitative study aimed to describe the experiences of people living with SCI with navigating and managing information in the community from their perspective. Methods: Participants were recruited through the Australian Quadriplegic Association. Twenty-two semi-structured in-depth interviews were conducted with purposively selected participants to ensure representation of age, gender, SCI level, and compensation status. Data were thematically analyzed using a framework approach. Results: People living with SCI reported using multiple, complementary sources of information to prevent and manage secondary conditions. Over time, they learned to appraise the content, relevance, timing, and sources of information. Information delivered by health professionals in the rehabilitation setting was appraised as lacking personalization, but it acted as a springboard to search for more relevant information. Participants described the process of becoming experts about their condition to overcome the lack of knowledge of many general practitioners, guide their own care, and act as a source of information for others. Due to a lack of information provision, some participants missed health improvement opportunities and experienced frustration at the uncertainty of their future with SCI. Conclusion: Greater support is required for individuals with SCI to navigate information sources in the community. Rehabilitation is an opportune time to provide education related to finding and appraising information. Improved access to community health providers with SCI knowledge is also required.

Perspectives From Family Caregivers of Persons With Spinal Cord Injury in Hospital Versus Rehabilitation: A Pilot Study

PURPOSE

The study aims to assess differences in family preferences for involvement in the ongoing care of a hospitalized family member with spinal cord injury based on whether the patient was hospitalized for initial rehabilitation (Group R) or hospitalized to treat secondary complications (Group C).

DESIGN

Explorative cross-sectional design.

METHOD

Family members rated the importance and experience of involvement on five subscales of the Patient Participation in Rehabilitation Questionnaire. Differences among the importance and experience scores between the groups were tested using the Mann-Whitney U test.

FINDINGS

Group C scored the importance to be involved significantly higher than Group R (M = 3.17 vs. M = 4.04, p =.01). No other significant differences between groups were detected.

CONCLUSION

Family members of patients hospitalized for secondary complications want greater involvement in care compared to those hospitalized for rehabilitation.

CLINICAL RELEVANCE

Results indicate the need for tailored interventions using a family-centered approach and ongoing needs assessment.

The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis

PURPOSE

The purpose of this thematic synthesis review was to identify and synthesise published qualitative research on the perspectives of individuals with spinal cord injuries with respect to physical rehabilitation interventions.

MATERIALS AND METHODS

The peer-reviewed literature was searched across seven databases and identified abstracts were independently screened by two reviewers. A thematic synthesis methodology was used to code and synthesise the results from the included studies.

RESULTS

In total, 7233 abstracts were identified; 31 articles were selected for inclusion, representing 26 physical rehabilitation interventions. The methodological quality of studies was moderate (Standards for Reporting Qualitative Research mean ± standard deviation = 14.39 ± 3.61). The four main themes developed were: (1) Benefits of physical rehabilitation, (2) Challenges of physical rehabilitation, (3) Need for support, and (4) Issue of control.

CONCLUSIONS

This qualitative thematic synthesis provides key insights into the experiences of individuals with spinal cord injuries who received physical rehabilitation. Recommendations for practice, based on the findings, include creating a diverse, encouraging, and educational physical rehabilitation experience with supportive staff who focus on communication and person-centred care. Implications for Rehabilitation Physical rehabilitation provides psychological as well as physical benefits to people with spinal cord injuries, including motivation, hope, improved self-confidence, and acceptance. Challenges identified during physical rehabilitation for people with spinal cord injuries, such as comparisons, negative emotions, recovery expectations, and slow progress, should be addressed by healthcare professionals to ensure person-centred care. People with spinal cord injuries identified a need for support from health care professionals, family, and friends, as well other people with spinal cord injuries. There is an issue of control in physical rehabilitation for people with spinal cord injuries, which can result in a fight with oneself or with healthcare professionals to regain the control that has been lost.

Resilience and the rehabilitation of adult spinal cord injury survivors: A qualitative systematic review

AIM

To synthesize the qualitative research evidence that explored how survivors of adult spinal cord injury experience and make sense of resilience.

BACKGROUND

Spinal cord injury is often a sudden and unexpected life-changing event requiring complex and long-term rehabilitation. The development of resilience is essential in determining how spinal cord injury survivors negotiate this injury and rehabilitation.

DESIGN

A qualitative systematic review and thematic synthesis of the research evidence.

DATA SOURCES

CINAHL, PubMed, Embase, Scopus and PsycINFO were searched, no restriction dates were used.

REVIEW METHODS

Methodological quality was assessed using the Critical Appraisal Skills Programme checklist. Thematic synthesis focused on how survivors of adult spinal cord injury experience and make sense of resilience.

RESULTS

Six qualitative research articles reported the experiences of 84 spinal cord injury survivors. Themes identified were: uncertainty and regaining independence; prior experiences of resilience; adopting resilient thinking; and strengthening resilience through supports.

CONCLUSION

Recovery and rehabilitation following spinal cord survivors is influenced by the individual's capacity for resilience. Resilience may be influenced by previous life experiences and enhanced by supportive nursing staff encouraging self-efficacy. Survivors identified the need for active involvement in decision-making about their care to enable a sense of regaining control of their lives. This has the potential to have a significant impact on their self-efficacy and in turn health outcomes.

The influence of clarification and threats on life situation: patients' experiences 1 year after TSCI

INTRODUCTION

The study was conducted at the Spinal Cord Injury Centre of Western Denmark (VCR). The aim of the study was to explore patients' experiences following traumatic spinal cord injury and to identify characteristics of positive versus negative life situation 1 year post discharge from hospital rehabilitation. This was a qualitative study conducted using inductive content analysis.

CASE PRESENTATION

In this qualitative study seven patients were interviewed one year after discharge from initial rehabilitation at the VCR. The interviews were analysed using inductive content analysis.

DISCUSSION

We found that two categories condensed the patients' experiences of their life situation 1 year post discharge: 'clarification in relation to overall life situation' and 'threat to core competences'. The transversal analysis across the derived categories identified different combinations of clarification and threats to core competences explaining the patients' experiences: high degree of clarification combined with low degree of threat to core competences was indicative of positive life situation. Also, positive life situation was seen when a high degree of clarification compensated for high degree of threats on core competencies. In contrast, an overall stressful and negative life situation was influenced by poor clarification combined with a high degree of threat to core competences. However, when core competences can be transformed into new skills, threats were manageable. This study revealed that clarification related to overall life situation in combination with threat to core competences may explain traumatic spinal cord injury patients' overall life situation 1 year post discharge. An appropriate balance characterises a positive life situation. There might be a need to pay attention to patients who are challenged by low degree of clarification and high degree of threats on core competencies 1 year post discharge as this may influence the life situation negatively.

The experience of patients with ABI and their families during the hospital stay: A systematic review of qualitative literature

BACKGROUND

Patients with acquired brain injury (ABI) and their families have unique experiences and needs during the hospital stay; yet, limited literature exists on this topic. The purpose of this systematic review was to compile and synthesize literature on the experience of patients with ABI and their families during the hospital stay.

METHODS

A systematic review of qualitative studies was conducted by searching for studies from seven databases. Content analysis was used to analyse and synthesize studies' findings separately for the patient and family experience.

RESULTS

The initial search provided 2871 records. Ultimately, 11 studies relevant to the research question were included in this review. No studies were excluded based on critical quality appraisal. Findings on the patient experience showed patients had negative perceptions of the rehabilitation environment and a perceived need for information. Findings on the family experience included difficulty adjusting after the patient's injury, a desire to be involved in the patient's care, mixed feelings about staff support and a high perceived need for information.

CONCLUSIONS

Findings provide awareness for healthcare providers on the multifaceted experiences of patients with ABI and their families during the hospital stay, strategies to make care more patient- and family-centred and directions for future research.

Early Access to Vocational Rehabilitation for Inpatients with Spinal Cord Injury: A Qualitative Study of Patients' Perceptions

Background: A pilot early-intervention vocational rehabilitation program was conducted in Sydney, Australia, over a 2-year period. It was postulated that the early provision of integrated vocational rehabilitation services in the hospital settings for newly injured individuals would be well received and result in better employment and psychosocial health outcomes. Objective: The objective of this qualitative inquiry was to examine the perspectives of program participants who had completed the intervention about the timeliness, perceived value, and critical elements of the early intervention. Methods: A convenience sample of participants was selected by accessibility; participants were interviewed individually after discharge using a semi-structured approach. Transcripts of the interviews were created via audio recordings; interviews were transcribed verbatim, and the contents were analyzed thematically. Results: Thirteen participants aged from 19 to 60 years with varying levels of impairment and vocational backgrounds were interviewed from 7 to 21 months post injury. Overall, the early introduction of vocational rehabilitation services was well received and viewed positively. Emerging themes include sense of direction and distraction, advocacy, and support, with "hope" (early after injury) emerging as the overarching theme. Criticisms voiced about the program were that it was offered too early in the intensive care unit and there were competing interests and information overload in the early recovery phase. Conclusions: Vocational rehabilitation provided during inpatient rehabilitation appears appropriate, important, and valuable from patients' perspective. Early engagement results in feelings of hope and encourages patients to see the possibility of returning to work or education very early after injury, and it allows rehabilitation to be directed accordingly.

Spinal cord injury rehabilitation patient and physical therapist perspective: a pilot study

The objectives of this retrospective observational study were to explore physical therapists' perceived involvement of patients with SCI in physical therapy (PT) rehabilitation, second to explore individuals with SCI perceived involvement in PT rehabilitation, third to compare how patients and physical therapists perceive involvement in PT rehabilitation and last to explore patients' perceived involvement with satisfaction with life (SWL). This study was conducted in the United States. Two 11-item questionnaires were designed one for physical therapists and one for patients. The items were rated on a Likert-type agreement scale. Thirty physical therapists completed the patient involvement questionnaire for physical therapists and nine individuals with SCI completed the patient involvement questionnaire and SWL scale. We certify that all applicable governmental and institutional guidelines were followed during the course of this research. The results indicated that both physical therapists and patients were overall in agreement that patients were involved in their PT rehabilitation on most items. The two items that received the lowest Likert scores by the therapists and patients were friends and family involvement in therapy and gender-related issues. The item, individualized patient goals, received the largest discrepancy between therapists and patients. The sample size was too small to observe a trend with SWL and perceived involvement. Patients and PTs from this pilot overall agree patients are included in treatment; however, the discrepancy in scores related to individualized goals requires further research.

Important wheelchair skills for new manual wheelchair users: health care professional and wheelchair user perspectives

PURPOSE

The purpose of this project was to identify wheelchair skills currently being taught to new manual wheelchair users, identify areas of importance for manual wheelchair skills' training during initial rehabilitation, identify similarities and differences between the perspectives of health care professionals and manual wheelchair users and use the ICF to organize themes related to rehabilitation and learning how to use a manual wheelchair.

METHOD

Focus groups were conducted with health care professionals and experienced manual wheelchair users. ICF codes were used to identify focus group themes.

RESULTS

The Activities and Participation codes were more frequently used than Structure, Function and Environment codes. Wheelchair skills identified as important for new manual wheelchair users included propulsion techniques, transfers in an out of the wheelchair, providing maintenance to the wheelchair and navigating barriers such as curbs, ramps and rough terrain. Health care professionals and manual wheelchair users identified the need to incorporate the environment (home and community) into the wheelchair training program.

CONCLUSIONS

Identifying essential components for training the proper propulsion mechanics and wheelchair skills in new manual wheelchair users is an important step in preventing future health and participation restrictions. Implications for Rehabilitation Wheelchair skills are being addressed frequently during rehabilitation at the activity-dependent level. Propulsion techniques, transfers in an out of the wheelchair, providing maintenance to the wheelchair and navigating barriers such as curbs, ramps and rough terrain are important skills to address during wheelchair training. Environment factors (in the home and community) are important to incorporate into wheelchair training to maximize safe and multiple-environmental-setting uses of manual wheelchairs. The ICF has application to understanding manual wheelchair rehabilitation for wheelchair users and therapists for improving the understanding of manual wheelchair use.

Who decides? A qualitative study on the decisional roles of patients, their caregivers and doctors on the method of bladder drainage after spinal cord injury

STUDY DESIGN

Qualitative study using individual in-depth interviews.

OBJECTIVE

To explore the roles of patients, their caregivers and doctors when making decisions on the method of bladder drainage after spinal cord injury (SCI).

SETTING

Five public hospitals in Malaysia.

METHODS

Semistructured (one-to-one) interviews with 17 male patients with SCI, 4 caregivers and 10 rehabilitation professionals.

RESULTS

Eight themes describing the respective decisional roles of patients, their caregivers and doctors emerged from the analysis: patient's right and responsibilities, patient as an informed decision maker, forced to accept decision; surrogate decision maker, silent partner; doctor knows best, over-ride patient's decision, or reluctant decision maker. Both patients and doctors acknowledged the importance of patient autonomy but not all patients had the chance to practice it. Some felt that they were forced to accept the doctor's decision and even alleged that the doctor refused to accept their decision. Doctors considered the caregiver as the decision maker in cases that involved minors, elderly and those with tetraplegia. Some patients considered bladder problems an embarrassing subject to discuss with their caregivers and did not want their involvement. Doctors were described as knowledgeable and were trusted by patients and their caregivers to make the most appropriate option. Some doctors were happy to assume this role whereas some others saw themselves only as information providers.

CONCLUSIONS

A paternalistic model is prevalent in this decision-making process and there is a discrepancy between patients' preferred and actual decisional roles.

Physical therapy after spinal cord injury: a systematic review of treatments focused on participation

Context Over the last four decades, the focus of spinal cord injury (SCI) rehabilitation has shifted from medical management to issues that affect quality of life and community participation. Physical therapists (PTs) need to design and implement interventions that result in maximal participation to provide an individual with SCI an effective rehabilitation program. Objective The aim of this review is to assess the extent, content, and outcomes of physical therapy (PT) interventions focused on improving the participation of individuals with SCI. Methods A search was conducted in Medline, Embase, CENTRAL, CINAHL, PEDro, and PsycINFO. We included studies, of all designs, focused on improving the participation of individuals with SCI using PT interventions.The primary author and a reviewer independently selected articles for inclusion, assessed articles quality, and extracted the data. Results Five studies met the inclusion criteria. The interventions applied were 9- and 12-month body weight-supported treadmill training in two studies, a supervised 9-month exercise program, a 12-week home exercise program, and a 10-week multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain. Four of five PT interventions positively impacted the individual's perceived participation and satisfaction with participation. Conclusion The body of research by PTs on interventions to improve participation is limited. PTs must document the effects of interventions with a valid outcome tool to enable more research that examines participation. Expanding participation research will allow PTs to meet the needs of individuals with SCI and identify what interventions best facilitate integration into the community.

Training professionals’ communication and motivation skills to improve spinal cord injury patients’ satisfaction and clinical outcomes: Study protocol of the ESPELMA trial

Acute spinal cord injury leaves patients severely impaired and generates high levels of psychological distress among them and their families, which can cause a less active role in rehabilitation, worse functional recovery, and less perceived satisfaction with the results. Additionally, rehabilitation professionals who deal with this psychological distress could ultimately experience higher stress and more risk of burnout. This article presents the study protocol of the ESPELMA project, aimed to train rehabilitation professionals in the clinical management of acute spinal cord injury–associated psychological distress, and to measure the impact of this training on the patients’ perceived satisfaction with treatment.

Patient Participation in Rehabilitation Questionnaire (PPRQ)-development and psychometric evaluation

STUDY DESIGN

A cross-sectional postal questionnaire study.

OBJECTIVES

The aim of the study was to evaluate selected psychometric properties of a draft version of the Patient Participation in Rehabilitation Questionnaire (PPRQ) measuring patients' experiences of participation in care and rehabilitation.

SETTING

Sweden.

METHODS

On the basis of previous qualitative analyses of patient interview data, a 32-item questionnaire covering five domains of participation was developed and sent to 268 persons with spinal cord injury, aged 18-80 years and injured 1-12 years previously. In total, 141 (51%) evaluable questionnaires were returned. Multi-trait analysis was used to assess scaling assumptions by testing item convergent and discriminant validity and internal consistency reliability (Cronbach's α) associated with the hypothesized item-scale structure of the questionnaire.

RESULT

Nine items failed to meet scaling assumptions and were omitted. Scaling assumptions were thereafter substantiated for the scales: 'respect and integrity' (6 items); 'planning and decision-making' (4 items); 'information and knowledge' (4 items); 'motivation and encouragement' (5 items); and 'involvement of family' (4 items). Item-scale correlations ranged from 0.67 to 0.85 and most items correlated higher or significantly higher with their hypothesized scale than with other scales. Cronbach's α was 0.89 for all scales.

CONCLUSION

The PPRQ appears to adequately assess central aspects of participation in care and rehabilitation from the perspective of patients with spinal cord injury. Further studies using larger samples will be undertaken to confirm the scale structure as well as the sensitivity and responsiveness of the questionnaire.

Patient participation in care and rehabilitation from the perspective of patients with spinal cord injury

STUDY DESIGN

Qualitative method, semi-structured interviews.

OBJECTIVES

The aim of the study was to explore the meaning of patient participation in care and rehabilitation from the perspective of patients with spinal cord injury (SCI).

SETTING

Post discharge community setting.

METHODS

Semi-structured interviews were performed with 10 persons with SCI representing different ages, gender and levels of injury. All interviews were conducted individually and lasted 40-120 min. The interviews were verbally transcribed and the data were analyzed by means of content analysis.

RESULTS

All informants stressed the importance of patient participation as a necessary prerequisite for successful care and rehabilitation, but emphasized that participation must be tailored to each patient's own preferences, capacities and needs. They also underscored that the staff should be sensitive and responsive to the fact that desired levels and kinds of participation may vary from patient to patient, as well as for the same patient during the course of the rehabilitation. Five themes reflecting central aspects of participation emerged: respect and integrity, planning and decision-making, information and knowledge, motivation and encouragement, and involvement of family.

CONCLUSIONS

Patient participation is a critical component of successful SCI rehabilitation and must be facilitated, promoted and tailored to each patient by the staff. Based on the finding from this study a questionnaire has been developed for assessing patient experiences of five domains of participation in rehabilitation to serve as a tool to help in evaluating provided care and in identifying patients' preferences for participation.

Getting on with life: positive experiences of living with a spinal cord injury

Currently, the dominant cultural beliefs toward disability are negative, and the existing literature is limited with respect to examining how people are using and/or viewing their disabilities positively. The purpose of this study was to identify how individuals living with a spinal cord injury (SCI) viewed and/or used their disability positively, and what contextual influences facilitated this positive approach. This study was a secondary analysis of qualitative data from a larger study. The findings revealed three levels at which disability was viewed and/or used positively by people with SCI: self, peers, and disability community. In addition, several aspects of the participants' situations were found to facilitate this positive view and/or use of disability: personality, spirituality, support systems, and acceptance of one's disability. The findings reveal that individuals with SCI are viewing and/or using their disabilities positively in many different ways. This study has significant implications for the direction of future research and for health care professionals who need to increase their advocacy and facilitating roles.

Towards personalized care for persons with spinal cord injury: a study on patients' perceptions

OBJECTIVE/BACKGROUND

A newly designed Spinal Cord Unit (SCU) was set up at the Orthopedic Traumatology Center (OTC), Turin, Italy, in July 2007. With the relocation of the SCU came the need to reorganize and improve the delivery of its services. The study reported here is a preliminary part of a project entitled 'Experimentation and evaluation of personalized healthcare for patients with spinal cord injury', which is a component of an overarching program of targeted research into healthcare funded by the Piedmont Region in 2006. The aim of this study was to assess the perception of care by patients with spinal cord injury (SCI) by collecting important data in order to determine whether an integrated and personalized care pathway could be effective both in hospital and in a rehabilitation setting.

DESIGN

Qualitative research study. The interview format was based on a narrative approach.

METHODS

Qualitative in-depth semi-structured interviews were conducted with 21 patients with SCI. Qualitative content analysis was used to identify categories and themes arising from the data.

RESULTS

Six main categories emerged from the perspectives of patients: expectations of rehabilitation care, impact and welcome, relationship with nurses and their involvement in treatment, relationship with physical therapists and participation in rehabilitation programs, relationship with physicians and their availability and attendance, and imparting of information on injury and rehabilitation outcomes. Care was the aspect new patients admitted to the SCU found most important. When closer relationships with staff formed, the healthcare professionals became an essential support. Patients with SCI commonly stated that receiving explicit information was necessary for accepting their condition.

CONCLUSIONS

Analysis of the patients' perceptions revealed a wealth of details on their experience in the SCU and the need for flexible planning of care time in particular. Incorporating the patients' perceptions into a new care model could increase professionals' awareness of patients' needs and provide a useful basis for constructing a personalized care plan.