Leaving a spinal unit and returning to the wider community: an interpretative phenomenological analysis

Abstract

Purpose: The study investigated the experience of community (re)integration from the perspective of people with spinal cord injury (SCI) within 12 months of discharge from a specialist spinal injuries unit in New Zealand (NZ).Method: Nine participants were interviewed. The verbatim transcripts were analysed using Interpretive Phenomenological Analysis (IPA).Results: Three main themes were: Leaving, Not Coping with a Capital C, and Power and Control. Leaving related to the process of planning for, and discharge from the spinal unit. Not Coping with a Capital C incorporated the coping and adjustment to life following a SCI, including the role of hope. Power and Control denoted the alteration in balance of power and control following SCI which was evident both in the rehabilitation facility and within the wider community setting.Conclusions: The results indicated that the spinal unit may not adequately equip the recovering person with SCI for life in the real world. Individuals with SCI returning to the community remained hopeful of recovery of function and or cure; this focus, particularly on physical rehabilitation, potentially reduced their availability for other forms of community reintegration such as work and leisure activities.Implications for RehabilitationParticipants may benefit from a focus on real world activities during rehabilitation following SCI.Clinicians need to teach skills not only specific to the rehabilitation environment, but problem-solving skills or methods to adapt skills to enable recovering persons to manage environments encountered at home in the “real world”. One simple example would be to carry out varied community outings as part of the “rehabilitation experience.”Participants were focussed on the two year period following SCI as one in which they remained hopeful of further recovery of function and or cure, this may delay participation in other aspects of community reintegration. Clinicians may be able to reframe traditional therapy into more integrative activities such as attending a community gym with friends, or home based exercises which do not rely on therapist input to encourage community reintegration.