Publication:


abstract

study DESIGN:

Observational cohort study.

OBJECTIVES:

To evaluate ongoing health and community reintegration of patients with spinal cord injury (SCI) after discharge from inpatient rehabilitation in Nepal.

SETTING:

Nepal.

METHODS:

This study Follows a cohort of 37 patients with SCI in Nepal, 1-2 years after discharge from inpatient rehabilitation in 2007. Participants were visited at home and data were obtained through semi-structured interviews that evaluated health, independence in daily living (Modified Barthel Index), community participation (Participation Scale) and barriers due to socioeconomic issues, housing, accessibility, and availability and use of mobility aids.

RESULTS:

One-quarter of the cohort had died (35% of wheelchair users). Secondary health concerns, such as pressure ulcers and urinary tract infections, were common in the 24 patients interviewed, and eight had been rehospitalized to treat them. Inappropriate wheelchairs, inadequate housing and rugged terrain restricted accessibility. 80% of wheelchair users could not enter their homes independently and 74% of those who were using mobility aids could not access the community independently because of the physical terrain. Of all those who were interviewed, half had no accessible toilet, access to a water source or road access to their home. Community participation was a challenge for most using mobility devices, and less than half earned any income.

CONCLUSION:

This study identifies important areas of focus for rehabilitation centres in less-resourced contexts like Nepal to help with reintegration after discharge: vocational training during or after rehabilitation; accessible housing; wheelchairs appropriate to the terrain and the need for strong community-based rehabilitation.

Related Articles
Relationship between manual wheelchair skill performance and participation of persons with spinal cord injuries 1 year after discharge from inpatient rehabilitation.
J Rehabil Res Dev. 2005
Relationship between manual wheelchair skill performance and participation of persons with spinal cord injuries 1 year after discharge from inpatient rehabilitation.
Kilkens OJ, Post MW, Dallmeijer AJ, van Asbeck FW, van der Woude LH. J Rehabil Res Dev. 2005 May-Jun; 42(3 Suppl 1):65-73.
Association of environmental factors with levels of home and community participation in an adult rehabilitation cohort.
Arch Phys Med Rehabil. 2006
Association of environmental factors with levels of home and community participation in an adult rehabilitation cohort.
Keysor JJ, Jette AM, Coster W, Bettger JP, Haley SM. Arch Phys Med Rehabil. 2006 Dec; 87(12):1566-75.
Is manual wheelchair satisfaction related to active lifestyle and participation in people with a spinal cord injury?
Spinal Cord. 2011
Is manual wheelchair satisfaction related to active lifestyle and participation in people with a spinal cord injury?
de Groot S, Post MW, Bongers-Janssen HM, Bloemen-Vrencken JH, van der Woude LH. Spinal Cord. 2011 Apr; 49(4):560-5. Epub 2010 Nov 2.
Review Systematic reviews of the effectiveness of day care for people with severe mental disorders: (1) acute day hospital versus admission; (2) vocational rehabilitation; (3) day hospital versus outpatient care.
Health Technol Assess. 2001
Review Systematic reviews of the effectiveness of day care for people with severe mental disorders: (1) acute day hospital versus admission; (2) vocational rehabilitation; (3) day hospital versus outpatient care.
Marshall M, Crowther R, Almaraz-Serrano A, Creed F, Sledge W, Kluiter H, Roberts C, Hill E, Wiersma D, Bond GR, et al. Health Technol Assess. 2001; 5(21):1-75.
Review The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Home-based compared with hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence.
Health Technol Assess. 2007
Review The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Home-based compared with hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence.
Jolly K, Taylor R, Lip GY, Greenfield S, Raftery J, Mant J, Lane D, Jones M, Lee KW, Stevens A. Health Technol Assess. 2007 Sep; 11(35):1-118.