Barriers and Facilitators during Community Participation of Spinal Cord Injury Patients after Completing Rehabilitation : a qualitative study

Abstract

Background: Spinal cord injury (SCI) is a life-changing injury that is associated with physical incapacitation and social reintegration struggles. We know that people with spinal cord injury have unique challenges as they transition through life, leaving rehabilitation centres, that have huge impact on their ability to engage meaningfully with their communities. Objective: The aim of this research was to explore the barriers and facilitators that influence community participation among spinal cord injury patients after completing rehabilitation. Methodology: A qualitative methodology was used, and face-to-face semi-structured interviews were carried out based upon feedback from ten participants with spinal cord injury (SCI) who had participated in inpatient rehabilitation at the Centre for the Rehabilitation of the Paralysed (CRP), Savar, Bangladesh. Thematic analysis was used to explore data for recurring themes and patterns relevant to participation within the community at discharge. Results: Seven main topics emerged. Major barriers included transit and road issues, dependence on adaptive equipment, physical pain, the need for help with activities of daily living, social stigma, and psychological distress. In contrast, strong family and spousal support, self- or employed, use of available resources at CRP, structured health routines, encouragement from peers and desire for independence were identified as significant facilitators. These themes emphasize the interplay of environmental, psychological, social, and institutional factors. Discussion: Study highlights illustrate that while environmental barriers significantly impact re-entry, determinants of participation are highly individualized and driven by motivation in social support. Interventions related to these areas must be geared towards increasing accessibility, decreasing stigma, and developing models of peer support to truly achieve inclusion and quality of life for those with spinal cord injury after generally accepted rehabilitation. Keywords: spinal cord injury, community participation, rehabilitation, qualitative study, barriers, facilitators.