Level of Participation and Its Associated Factors among Children & Adolescent with Spinal Cord Injury: An Analytical Cross-Sectional Study

Abstract

Background: Spinal cord injury (SCI) is a life-altering condition that significantly affects physical functioning, psychosocial well-being, and participation in everyday life. Children and adolescents with SCI often experience substantial challenges in engaging in home, school, and community activities due to injury-related impairments, environmental barriers, and social factors such as bullying and limited accessibility. Understanding participation levels and the factors influencing participation among this population is essential for guiding effective rehabilitation and community reintegration strategies, particularly in low- and middle-income countries like Bangladesh, where evidence remains limited. Aim: To assess the level of participation and it’s associated factors among children and adolescents with spinal cord injury living in the community. Methods: An analytical cross-sectional quantitative study was conducted among 53 children and adolescents with spinal cord injury whose age was 5-17 years and completed inpatient rehabilitation from CRP, and were living in the community. Standardised questionnaires (CASP & CASE) were used to collect data on the level of participation across home, school, neighborhood & community, & it’s associated factors. The data were analyzed using the SPSS 20 version for descriptive and inferential analysis, including Mann–Whitney U tests and linear regression. Participants were selected using convenience sampling. Results: The mean age of participants was 13.68 ± 3.49 years, with the majority being male (60.4%) and residing in rural areas (60.4%). Participation was most limited in school, community, and home & community living activities, while home participation showed relatively better outcomes. A high proportion of participants reported significant environmental problems (60.4%) and experiences of bullying (58.5%). Children with paraplegia demonstrated significantly higher overall participation compared to those with tetraplegia (P < 0.05). Involvement in institution-based programs and absence of school dropout were significantly associated with higher participation across multiple domains (P < 0.05). Linear regression analysis revealed that paraplegia, participation in institutional programs, and continued school engagement were significant predictors of higher participation, whereas lack of institutional involvement was associated with greater environmental barriers. Conclusion: The findings indicate that children and adolescents with SCI in Bangladesh experience considerable participation restrictions, particularly in school and community settings, largely influenced by injury severity, school dropout, institutional involvement, and environmental barriers. Comprehensive, participation-focused rehabilitation approaches that integrate physical, educational, psychosocial, and environmental interventions are essential to enhance community inclusion and quality of life for this population. Keywords: Participation, Children and Adolescents, Spinal Cord Injury, Environmental Barriers,