Spinal Cord Injury Survivors Research Articles

Exploring the relationship of clinical walking tests with 8-months inertial measurement unit (IMU)-based real world mobility tracking in stroke and spinal cord injury survivors

BackgroundMobility is crucial for participation and quality of life in individuals with sensorimotor impairments, yet scientific evidence on its course in real-world settings is limited. So-called wearables for measuring physical activity might help to overcome this knowledge gap allowing daily measurements of mobility. The aim of the present study is to examine the relationship between clinical walking tests and inertial measurement unit-based mobility tracking in the community setting of stroke and spinal cord injury (SCI) survivors.MethodsAt a single observational time point, the precision of the activity tracker was evaluated in a standardized parcours in healthy subjects and stroke or SCI survivors (n=57). This was followed by a multicenter observational cohort study (n=116 participants), in which the mobility of stroke and SCI survivors was assessed over 8 months immediately after discharge from acute inpatient rehabilitation. Daily distances covered in the community setting were recorded using the activity tracker. Established walking tests—including the 10-meter walk test (10MWT) and the timed up and go test (TUG)—were conducted at baseline, as well as at 4- and 8-month follow up visits. The relationship between daily distances in the ambulatory setting and 10MWT or TUG performance at discrete study visits (baseline, 4 months (midterm), and 8 months (final) after hospital discharge) was analyzed using regression models.ResultsThe precision of the activity tracker in measuring covered distance in a standardized parcours varied by mobility type. The highest precision was achieved in manual wheelchair users (deviation from zero: -1.5±1.03% (p=0.15) while the least favorable precision was observed in participants with SCI and significant walking impairment (-14.6±2% (p<0.001). The widely used 10MWT speed showed a relationship with the ambulatory daily distance. The regression coefficients [m/(1m/s)] were: 874 (95% CI: 578-1171) at baseline (p<0.001), 895 (95% CI: 614-1176) at midterm (p<0.001), and 824 (95% CI: 537-1112) at the final visit (p<0.001). Interestingly, in the category of good walkers with the most favorable walking speeds the daily covered distance unmasked distinct subgroups with shorter and longer daily distances.ConclusionsFor SCI and stroke survivors, especially medium to fast walkers, activity tracking in real-world settings adds valuable insight beyond clinical walking tests. Clinical studies on rehabilitative interventions for mobility improvement should consider real-life daily distance as a key endpoint.

Revealing the protective mindfulness-moderation on loneliness, depression, and quality of life among spinal cord injury survivors in a mixed-methods study

Purpose Loneliness, prevalent in people with spinal cord injuries (SCI), is negatively associated with mental health and quality of life. Mindfulness is a potential moderator that may buffer the negative impact of loneliness. This study aimed to explore the moderation effects of mindfulness on the relationship between loneliness, depression, and quality of life among people with SCI. Methods We conducted an explanatory sequential mixed-methods study on SCI survivors in Hong Kong. Survey data (n = 72) including socio-demographics, mindfulness, loneliness, depression, and quality of life were analyzed using moderated regression with the SPSS PROCESS macro. Focus group interviews (n = 15) were analyzed using thematic analysis. Results Mindfulness significantly moderated the positive association between loneliness and depression (B= −0.060, p = 0.006), and a cutoff value (>116.569) for moderation was identified. The mindfulness moderation on the relationship between loneliness and quality of life was insignificant. Three themes were generated: connectedness contributes to subjective well-being, mindful perceptions foster emotional resilience and happiness, and mindful perceptions enhance physical health and social connections. Conclusions This study revealed the protective moderation mechanism of mindfulness in buffering the negative impacts of loneliness on depression, providing a strong theoretical foundation for the use of mindfulness-based interventions in improving mental well-being among SCI survivors.

EMOTIONAL COMPETENCE AND QUALITY OF LIFE OF REHABILITATED SURVIVORS OF SPINAL CORD INJURY WITH SPECIAL REFERENCE TO SIPA

This research investigates emotional competence and quality of life among 209 rehabilitated spinal cord injury survivors, selected randomly. Emotional competence, covering both intrapersonal and interpersonal skills, is crucial for adjusting post-rehabilitation (Brackett, Rivers, &amp; Salovey, 2011). Participants used the Short Profile of Emotional Competence (S-PEC) (Brasseur &amp; Mikolajczak, 2013) and the Quality of Life scale (John Flanagan, 1970) to assess emotional skills and various life dimensions. The study revealed significant links between higher emotional competence and better quality of life, influenced by factors like age, gender, occupation, injury type, and duration. Those receiving more social support during rehabilitation demonstrated higher emotional competence and improved quality of life. Moreover, different levels of emotional competence were observed, with higher intrapersonal competence associated with better emotional understanding and management, and higher interpersonal competence linked to enhanced social awareness and interaction management. These results highlight the importance of incorporating emotional competence training into rehabilitation programs, indicating that comprehensive approaches could have enduring benefits for the well-being and social integration of spinal cord injury survivors.

Effect of Skill Demonstration On Clean Intermittent Self Catheterization Among Spinal Cord Injury Survivors

BackgroundCISC is a valuable procedure for survivors of Spinal Cord Injury to use in managing urinary incontinence, which can cause complications like reinfection by Urinary Tract Infections and problems with the bladder. Nevertheless, many patients with an SCI are still challenged to master CISC; hence, it is essential to identify adequate training strategies.AimThe purpose of this research was to assess the effectiveness of using skill demonstration on the overall effectiveness of CISC in increasing technical proficiency, assertiveness, and self-sufficiency among SCI survivors.MethodsQuasi-experimental research was used in this study, which was carried out at the Paraplegic Centre Hayatabad Peshawar with a sample of 54 participants selected through a convenient sampling technique. Information was obtained with a translated and cross-culturally adapted 12-item checklist of CISC performance that evaluated the performance before and after an intervention with the teaching of hands-on skills. To compare the pre and post-experimental data, the results of the paired sample t-tests and the Chi-square test were obtained to check the efficacy of the behavioral intervention.ResultsThe results showed a positive shift in mean practice scores from pre-intervention (70.25%) to post-intervention (94.52%) in CISC skills, Wilcoxon test p &lt; 0.0001. Concerning the intervention proposal, there was a significant improvement in good practice, with the number rising from 18.5% pre-intervention to 74.1% post-intervention. While receptiveness to change was influenced by education level and previous training in CISC, age and marital status did not impact the results.ConclusionImplementation of skills has demonstrated a positive impact on improving the CISC among SCI survivors and controlling complications. These results indicate the need to include practical cases in the training methods used to teach SCIs to become more self-sufficient in their everyday lives.

Integrating Stakeholder Input to Develop a Robotic Gait Training Intervention for People With Spinal Cord Injury: A Brief Report

Individuals with disability, like survivors of spinal cord injury (SCI), are necessary partners in the development of evidence-based health promotion programs. As a Community-Based Participatory Research approach is often difficult to feasibly implement for certain time-limited projects, we utilized a community advisory board (CAB), including individuals with SCI lived experience, to develop a robotic exoskeleton gait training program during inpatient rehabilitation using a randomized clinical trial (RCT) design. We describe how we identified and included individuals with lived experience into our CAB from the proposal stage through study execution. Phases of engagement included: 1) collaboratively adapting the program, 2) refining the program and study procedures and measures, and 3) collecting data and reviewing outcomes. We also conducted a lived experience consultant survey following conclusion of the project. Several changes were made to the RCT based on CAB input, including changing inclusion and exclusion criteria, utilizing the clinical team, adjusting the protocol to reflect patient clinical needs, and changes to data collection measures. Overall, engagement and feedback suggest our approach was successful in engaging community members throughout all phases of our multi-year RCT. Retention of CAB members was excellent with an average attendance of 70% across all quarterly meetings. Survey feedback suggests that individuals with lived experience considered their input valuable and meaningful. Suggestions for changes included increasing compensation, balancing virtual and in-person meetings, and utilizing people with lived experience for recruitment efforts.

Unraveling spinal cord injury caregiver burden in Indonesia

Diverse cultural, social, and economic backgrounds significantly influence the caregiver burden of spinal cord injury (SCI) patients, affecting their quality of life (QoL) and the overall care experience. This study was done to identify spinal cord caregivers' QoL in Indonesia through their burden and the variables that influence it. A cross-sectional study was conducted at Dr. Hasan Sadikin Hospital, Bandung, Indonesia, involved 137 primary SCI caregivers. The burden of these caregivers was evaluated using the Indonesian version of the Zarit Burden Interview (ZBI) and the World Health Organization Quality of Life-BREF questionnaires. The data was analyzed with multiple linear regression and spearman analysis using SPSS version 24. The majority of SCI caregivers have a mild to moderate burden (54.7%). The burden score was significantly correlated, especially with occupational status and the length of interaction each day (p&amp;lt;0.001). It also found a significant with strong negative correlation (referring to the Guilford criteria) between caregiver burden and QoL (r-value −0.750; p-value &amp;lt;0.001). Indonesian caregivers' cultural and economic backgrounds may alleviate their burden in caregiving, but attention to patient occupational status and care duration is crucial to prevent worsening their quality of life, particularly for SCI survivors they care for.

Caring for Carers: Association between Care-giving and Quality of Life of Family Carers of Spinal Cord Injury Survivors in Pakistan

Caring for someone with a spinal cord injury (SCI) has always been a family endeavor in developed as well as developing countries like Pakistan. Majority of people with SCI need assistance of others to carry out daily life activities i.e., eating, self-care, transportation and this functional dependence of patients on their attendant affect Quality of Life (QOL) of caregivers. Present study was designed to find the relationship between caregiver burden, psychosocial factors and QOL among caregivers. Caregiver Burden Inventory-SCI and WHOQOL was used to measure study variables. Cross-sectional research design having purposive sampling technique was used to gather data from spinal units of various hospitals of Pakistan. Sample size includes N= 255 family caregivers of SCI patients. Correlation analyses were applied to find the relationship between psychosocial factors, caregiver burden and QOL. Results showed that caregiver burden was significantly negatively correlated with quality of life and positively correlated with care-giving hours, duration of injury, and number of helpers involved in care-giving process. Furthermore, female caregivers showed high level caregiver burden and low levels of quality of life as compared to male counterparts. Similarly, married persons scored higher on caregiver burden and whose patients had paraplegic nature of injury. In Pakistan, there are no respite care programs for carers, The abovementioned findings are helpful in planning psychotherapeutic interventions and tailored caregiver training programs to lessen the impact of caregiver burden on caregivers and to boost their quality of life.

There Is More to Life Than Walking: A Qualitative Study of Survivorship Among Peer Mentors in the Spinal Cord Injury Community.

Objective: To identify factors impacting survivorship among people living with spinal cord injury (SCI) and volunteering in a peer mentorship program. Research Method/Design: Semi-structured interviews were conducted by a leader of a non-profit organization designed to promote independent living after SCI. Questions explored intrinsic factors such as resilience and emotional coping as well extrinsic factors such as family support and accessibility challenges that impacted their SCI survivorship journey. Two independent anonymous reviewers conducted thematic analysis to identify these factors. Results: Twenty-eight members of the SCI peer mentorship program participated. Four themes affecting survivorship were identified: Sense of Achievement, Post-Injury Growth, Post-Injury Challenges, and Giving and Receiving Support. Nearly all participants focused their responses on Post-Injury Growth and Giving and Receiving Support as reasons for their interest in serving as peer mentors. Conclusions: This study highlights a need for peer community integration following SCI and underscores the importance of using a community-driven participatory model to inform and guide research. Peer mentorship programs can link SCI survivors to mentors and facilitate other sources of social fulfillment and thus can have a profound impact on individuals' survivorship post-SCI. This study identified a Sense of Achievement, Post-Injury Growth, Giving and Receiving Support, and Post-Injury Challenges as factors that most impact the SCI survivorship journey. This community leader's work underscores the importance of cognitive framing and social networks in post-injury rehabilitation in this population. Future directions include analyzing the longitudinal effects of peer mentorship participation on life satisfaction and community building in individuals living with SCI.

Prolonged exposure for posttraumatic stress disorder following spinal cord injury: A randomized controlled trial.

Individuals with a spinal cord injury (SCI) may experience posttraumatic stress disorder (PTSD) at a higher rate, which is associated with worse psychiatric comorbidity, decreased quality of life, and greater disability. Yet, effective PTSD interventions remain understudied for individuals with SCI. We conducted the first randomized controlled trial (RCT) of an evidence-based psychotherapy (prolonged exposure [PE]) with survivors of SCI during acute rehabilitation. We examined the efficacy, feasibility, and secondary outcomes. Participants (n = 29) were adults recruited from 2018 to 2021 1-month postinjury with PTSD randomized into either PE therapy or treatment as usual. The primary outcome was PTSD assessed at baseline, 6, 10, and 32 weeks postenrollment. An overall group-by-time interaction was not statistically significant (p = .102), but effect sizes demonstrated moderate and large improvements in PTSD for the PE group at 6 (-19.4 vs. -9.7) and 10 (-25.8 vs. -5.7), respectively. Similarly, moderate to large effect sizes were observed for depression, maladaptive posttraumatic cognitions, disruptive nocturnal behaviors, SCI-related quality of life, and risky alcohol consumption. Low rates of enrollment (50%) and treatment completion (25%) suggest feasibility challenges; however, treatment completers did report high satisfaction (100%). Results suggest that individuals who received PE had a quicker and clinically meaningful reduction in PTSD symptoms, but delivery during acute rehabilitation is not feasible for many individuals. Future research should examine abbreviated versions of PE for PTSD to enhance the feasibility of treatment in this setting. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Traumatic Cervical Spinal Cord Injury and Income and Employment Status

Spinal cord injury (SCI) causes drastic changes to an individual's physical health that may be associated with the ability to work. To estimate the association of SCI with individual earnings and employment status using national administrative health databases linked to income tax data. This was a retrospective, national, population-based cohort study of adults who were hospitalized with cervical SCI in Canada between January 2005 and December 2017. All acute care hospitalizations for SCI of adults ages 18 to 64 years were included. A comparison group was constructed by sampling from individuals in the injured cohort. Fiscal information from their preinjury years was used for comparison. The injured cohort was matched with the comparison group based on age, sex, marital status, province of residence, self-employment status, earnings, and employment status in the year prior to injury. Data were analyzed from August 2022 to January 2023. The first outcome was the change in individual annual earnings up to 5 years after injury. The change in mean yearly earnings was assessed using a linear mixed-effects differences-in-differences regression. Income values are reported in 2022 Canadian dollars (CAD $1.00 = US $0.73). The second outcome was the change in employment status up to 5 years after injury. A multivariable probit regression model was used to compare proportions of individuals employed among those who had experienced SCI and the paired comparison group of participants. A total of 1630 patients with SCI (mean [SD] age, 47 [13] years; 1304 male [80.0%]) were matched to patients in a preinjury comparison group (resampled from the same 1630 patients in the SCI group). The mean (SD) of preinjury wage earnings was CAD $46 000 ($48 252). The annual decline in individual earnings was CAD $20 275 (95% CI, -$24 455 to -$16 095) in the first year after injury and CAD $20 348 (95% CI, -$24 710 to -$15 985) in the fifth year after injury. At 5 years after injury, 52% of individuals who had an injury were working compared with 79% individuals in the preinjury comparison group. SCI survivors had a decrease in employment of 17.1 percentage points (95% CI, 14.5 to 19.7 percentage points) in the first year after injury and 17.8 percentage points (14.5 to 21.1 percentage points) in the fifth year after injury. In this study, SCI was associated with a decline in earnings and employment up to 5 years after injury for adults aged 18 to 64 years in Canada.

Effect of a Mindfulness and Motivational Interviewing-Oriented Physical-Psychological Integrative Intervention for Community-Dwelling Spinal Cord Injury Survivors: A Mixed-Methods Randomized Controlled Trial

Effect of a Mindfulness and Motivational Interviewing-Oriented Physical-Psychological Integrative Intervention for Community-Dwelling Spinal Cord Injury Survivors: A Mixed-Methods Randomized Controlled Trial

Guidelines for chronic pain in adult spinal cord injury population: Scoping review.

Chronic pain among survivors of spinal cord injury (SCI) hurts physical and mental health. Persons with SCI have demonstrated dissatisfaction with the management of their chronic pain. This study aimed to identify existing clinical practice guidelines for chronic pain in the SCI population. A scoping review was conducted across various databases available at the University of the Western Cape, in addition to guideline clearing houses (BioMedCentral, Cambridge Journals Online, CINAHL, Cochrane Library, Medline [EbscoHost], Medline [Pubmed], Sabinet Reference, SAGE Journals Online, ScienceDirect, SCOPUS, Wiley Online Library, Springerlink, PubMed, Guideline Central, and Agency for Healthcare Research and Quality). The population consisted of adults with SCI, and the interventions that were included were pharmacological and nonpharmacological management of chronic pain. Guidelines that met the inclusion criteria were critically appraised by two reviewers from this study using the AGREE II instrument. Inter-rater reliability was calculated using SPSS 27, and Cohen's kappa coefficients were established. Five articles were included in the data extraction, analysis and appraisal. Two guidelines were rated as high quality, according to the AGREE II tool. In addition, most guidelines focused on neuropathic pain (NeuP) and only one guideline included nociceptive pain and NeuP. One guideline met the objectives of this scoping review. Guidelines developed in the future should include a screening tool to identify the specific type of pain and distinguish peripheral NeuP from central NeuP.

Clustering index analysis on EMG-Torque relation-based representation of complex neuromuscular changes after spinal cord injury

Clustering index analysis on EMG-Torque relation-based representation of complex neuromuscular changes after spinal cord injury

Assessment of Quality of Life in Patients with Spinal Cord Injury within the Period of First 6 Months after Injury

Introduction: Spinal cord injury (SCI) is a devastating neurological state resulting in long-term physical dependency, increased morbidity, emotional, and financial burden. This study sought to assess the quality of life in patients with spinal cord injury within the first six months after injury. Aim of the study: The aim of this study was to assess the quality of life in patients with spinal cord injury within the first six months after injury. Methods: This cross-sectional study was conducted at the Department of Physical Medicine &amp; Rehabilitation and Department of Neurosurgery in Bangabandhu Sheikh Mujib Medical University (BSMMU) over a period between October 2021 to September 2022. 21 patients with SCI within 6 months of injury were recruited. Interviews with a semi-structured questionnaire assessed demographics, SCI details, and QoL (WHOQOL-BREF). Neurological injury classification followed ASIA standards. Statistical analysis was performed using SPSS 24. Result: The majority of the studied patients (23.8%) were within the 41-50 and 51-60-year age groups. More than two-thirds of the studied patients (71.4%) were male. with falls (42.9%) and spinal tumors (19.0%) as leading causes. Among all, 33.3% of the patients had complete motor involvement. According to the score of the physical domain, 66.7% of patients had low QoL. Age was positively significantly correlated with the environmental QoL score (r: 0.532, p value: 0.013) Conclusion: SCI significantly impairs all aspects of quality of life, with complete SCI patients facing notably worse physical conditions. A collaborative approach involving health entities, families, and communities is essential to improve quality of life and self-care abilities for SCI survivors.

A Systematic Review: Exercise Based Approaches to Activate Central Pattern Generator in Spinal Cord Injury Survivors

&amp;lt;i&amp;gt;Background: &amp;lt;/i&amp;gt;Locomotion is a basic motor act which is essential for the survival of humans. The basic muscle synergies which are responsible for body propulsion are generated by the neurons in spinal cord collectively known as Central Pattern Generator for Locomotion. Spinal Cord is the major conduit for the transmission of information between brain and the rest of the body. Injury to the spinal cord is the insult to the neural elements of the spinal canal from foramen magnum to cauda equina. SCIs are heterogeneous in casualty, severity and location of injury but locomotion is the ultimate goal for the post-SCI survivors. In order for locomotion to occur, a complex CPG center of locomotion activation is required. Exercise based approach is the cornerstone in the treatment and management of individuals with SCI.&amp;lt;i&amp;gt; Objective&amp;lt;/i&amp;gt;: To study the existing evidence on the effectiveness of Exercise-based approaches to activate Central Pattern Generator in Spinal Cord Injury Survivors with a focus on randomized controlled trials and cross over trials studies. &amp;lt;i&amp;gt;Methodology&amp;lt;/i&amp;gt;: Literature published in English language. Original publications including RCTs and cross over trials published in peer-reviewed journals focused on traumatic or non-traumatic spinal cord injury published from 2014 to 2022. A key literature search adopted, for a more targeted search the following terms were used: effect of exercise, task-based approaches, body weight supported treadmill training, over ground training, balance and coordination training on the activation. &amp;lt;i&amp;gt;Search Strategy&amp;lt;/i&amp;gt;: Database used were PubMed, Cochrane, Scopus, EMBASE, CINAHL and Medline. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: Assessment of Risk of Bias was done using PeDro analysis. Eleven studies met the inclusion criteria out of 300 studies searched. &amp;lt;i&amp;gt;Discussion&amp;lt;/i&amp;gt;: Exercise based approaches are highly essential and integrated part of the rehabilitation of spinal cord injury survivors. It has been concluded that activity-based therapies are highly effective but under-utilized by the rehabilitation specialists.

Assessing Regional Weather's Impact on Spinal Cord Injury Survivors, Caregivers, and General Public in Miami, Florida.

(1) Background: Climate change is increasing the already frequent diverse extreme weather events (EWE) across geographic locations, directly and indirectly impacting human health. However, current ongoing research fails to address the magnitude of these indirect impacts, including healthcare access. Vulnerable populations such as persons with spinal cord injury (pSCI) face added physiologic burden such as thermoregulation or mobility challenges like closure of public transportation. Our exploratory research assessed commute and transport to healthcare facilities as well as the knowledge, attitudes and behaviors (KAB) of pSCI regarding EWE and climate change when compared to pSCI caregivers (CG) and the general public (GP). (2) Methods: A KAB survey was employed to conduct a cross-sectional assessment of pSCI, CG, and GP in Miami from October through November 2019 using snowball sampling. Descriptive and logistic regression statistical analyses were used. (3) Results: Of 65 eligible survey respondents, 27 (41.5%) were pSCI, 11 (17%) CG, and 27 (41.5%) GP. Overall, pSCI reported EWE, particularly flooding and heavy rain, affecting their daily activities including healthcare appointments, more frequently than CG or GP. The overall models for logistic regression looking at commute to and attendance of healthcare appointments were statistically significant. pSCI self-report being less vulnerable than others, and a large proportion of each group was not fully convinced climate change is happening. (4) Conclusions: This study provided insight to the KAB of 3 population subgroups in Miami, Florida. pSCI are significantly more vulnerable to the effects of regional weather events yet exhibit disproportionate self-perception of their vulnerability. Continued and more comprehensive research is needed to characterize the barriers that vulnerable populations face during weather events.

Psychosocial reintegration post-traumatic spinal cord injury in Rwanda: An exploratory study.

Traumatic spinal cord injury (TSCI) survivors are confronted by both physical and psychosocial barriers when returning to their communities. Therefore, reintegration is an important aspect of their journey back into social life. To assess psychosocial reintegration after TSCI in Rwanda. All community-dwelling adults who were registered in the previous epidemiological study were recruited and injury characteristics questionnaire and the Sydney Psychosocial Reintegration Scale version 2 (SPRS-2) were used to collect data through a telephone interview. The study traced 58 participants, 77.6% (n = 45) were male and 56.9% (n = 33) were categorised with paraplegia. Overall, the results show poor community reintegration. The SPRS-2 and domain mean (SD) scores were: overall SPRS-2 of 20.95 (11.56), occupational activity (OA) of 3.68 (4.31), interpersonal relationship (IR) of 7.11(4.31) and living skills (LS) of 7.43 (5.32). Gender significantly influenced overall SPRS-2 (p = 0.011) and two domains: OA (p = 0.005) and LS (p = 0.012). Level of injury was significantly associated with an OA domain score of SPRS-2 (p = 0.002). Gender explained 29% of the variance in the LS domain of SPRS-2, with males reporting better psychosocial reintegration. Gender strongly predicted psychosocial reintegration following a TSCI, which is an indication of the role of social support. Traumatic SCI rehabilitation should be holistic to help prepare the person to return to the community. There should be an assessment of an individual's readiness to return to the community before discharge from the hospital.

Increased Risk of Myocardial Infarction, Heart Failure, and Atrial Fibrillation After Spinal Cord Injury

Increased Risk of Myocardial Infarction, Heart Failure, and Atrial Fibrillation After Spinal Cord Injury

Experiences of people with spinal cord injuries readmitted for continence-related complications: a qualitative descriptive study.

Qualitative descriptive. To describe the experiences of people with Spinal Cord Injury (SCI) re-admitted to the hospital due to continence-related complications. Inpatient service of a large spinal unit in North-West of Italy. Semi-structured interviews were conducted on a purposive sample of people with SCI (n = 11; age range 22-66 years, n = 5 females, n = 6 with cervical injuries), audio-recorded, and transcribed verbatim (duration range 38-52 min). Data were analysed inductively using the thematic analysis approach as described by Braun and Clarke. Three main themes were identified: (i) managing the frustration of continence-related complications; (ii) finding your way to deal with continence-related complications; (iii) identifying precise needs to deal with continence-related complications. Obtained findings highlighted the perceived emotional and physical burden suffered by people with SCI and their caregivers regarding the constant look for solutions and renounces to social participation, the different strategies implemented to address continence-related complications, and the unmet or partially met needs of people with SCI regarding support in transition to the community, infrastructure, and reliable information or education. Continence-related complications have a significant impact on the lives of people with SCI and their families. Interventions using technological tools and peer participation could reduce the burden associated with continence-related complications. Specific instruments are needed to facilitate evaluation, goal setting, and promote discussion of continence to allow HCPs to support people with SCI. Structured follow-up for SCI survivors should also focus on their needs to improve knowledge, facilitate decision making, and promote preventive behaviours.

Does satisfaction with the manual wheelchair have an impact on the quality of life in spinal cord injury?

Background: Customised wheelchairs are integral component for comprehensive rehabilitation and community integration for spinal cord injury (SCI) survivors, while inappropriate wheelchairs negatively impact their functional independence, mobility and quality of life (QOL). Keeping this in mind, this study aimed to determine the effects of manual wheelchair users' satisfaction on QOL in SCI. Methods: This cross-sectional study, which included 112 SCI, was conducted at the Paraplegic Centre, Hayatabad, Peshawar, over a period of 6 months using "Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST)" and “World Health Organisation Quality of Life (WHOQOL-BREF)” as study tools. Results: QUEST showed a significant positive correlation with physical health (rs = 0.375; p&lt; 0.001), social relationships (rs=0.234; p = 0.013), and environmental health (rs = 0.462; p&lt;0.001) of QOL except psychological health, and similarly, overall health and overall QOL was positively impacted. Furthermore, overall health and environmental, social relationships, and physical domains of QOL were statistically significantly impacted by the QUEST device and service aspects. Conclusion: A moderate level of satisfaction among participants for both devices and services was observed, which also impacts their physical, environmental, and social domains of QOL. Therefore, steps from the key stakeholders are required to provide satisfactory appropriate wheelchairs to patients so their QOL can be improved.