To determine the functioning priorities of persons with chronic SCI in terms of impairments, activity limitations, and participation restrictions with the aim of strengthening healthcare services towards addressing morbidity needs.
A cross-sectional survey study design was used to recruit participants with chronic SCI in four of the nine provinces in South Africa. Participants had to be 18 years of age or older, acquired their SCI (either traumatic or non-traumatic), and reside in one of the included provinces. Eligible participants were recruitment via hospital registries and the largest non-profit organisation for persons with SCI in South Africa. The assessment was based on self-report, and participants needed to complete a 360 degrees evaluation of functioning including i) demographic and injury characteristics; ii) secondary medical conditions including mental functions, activity limitations and participation restrictions, iii) environmental factors; iv) health care utilisation and indicators; and v) quality of life. Descriptive statistical tests were used.
At this stage of the open-cohort study, 314 participants were enrolled, and 75% were men. The largest proportion (43%) of participants was between 31-45 years of age, and the majority (55%) were single. Approximately two-thirds (67.5%) have paraplegia. Concerning chronicity, 43% had their injuries for more than 16 years, and only one-in-five are currently employed. The leading secondary medical conditions include pain (59%), followed by spasticity (52%), and sexual dysfunction (47%), while the best treatment rates did not correspond with the leading complications. The top activity limitations and participation restrictions included standing without support for long period, such as 30min (69%), using public transport (84%), getting up off the floor lying on your back (45%), and getting where you want to go (38%).
The functioning priorities are diverse and have the potential to negatively influence quality of life. There is a need to audit the current evidence-base and care packages for rehabilitation to help ensure that the priorities are addressed.
There is a need to audit physiotherapy interventions used to address functioning problems in persons with SCI in South Africa against evidence-based guidance such as the World Health Organisations Package of Interventions for Rehabilitation and ensure adoption or contextualisation of best fit interventions. These findings could also advocate for health care policy reform for improved physiotherapy capacity at primary health care level.
Spinal Cord Injuries
Disability and Rehabilitation
