Mullerpatan Rajani, Ryain Aamreen, Padia Neha, Salgotra K R
MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India.
Department of Orthopedics, MGM Medical College, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India.
Brain Spine. 2025 Jun 21;5:104299. doi: 10.1016/j.bas.2025.104299. eCollection 2025.
Rehabilitation of individuals with spinal cord injury (SCI) is improving in tertiary-healthcare settings of low-middle-income countries (LMICs). However, rehabilitation and integration within the community is yet a distant target.
What are the patients-reported challenges in rehabilitation and community-integration which open opportunities to change lives of individuals with SCI.
Clinical-records and interviews of 24 adults with SCI were examined to report socio-demographic information, functioning, disability, cost-of-care, health-related- quality-of-life and environmental-barriers.
Fifty-percent individuals belonged to lower-middle socio-economic strata. Functioning independence (SCIM) was highest in indoor (9.0 ± 1.4); and least in outdoor-mobility (9.3 ± 4.0) 7.8yr after injury. Individuals from lower-income-strata had no access to indoor water(n = 5) and toilet(n = 8) facilities. WHO-QoL was lowest (39.5 ± 15.0) in environmental domain. Seventy-percent individuals employed before SCI, could not return to previous jobs. Post-injury, 8 were employed in alternate lesser paid jobs; whereas 16 were dependent on family. Cost-of-care was covered either by self(n = 1), government health-insurance (n = 1); private health-insurance (n = 3); employer (n = 5); NGO (n = 2), family (n = 12).
Patient-reported challenges in rehabilitation and community-integration of individuals with SCI, highlight gaps in access to basic amenities in houses, inaccessible transport and public spaces and financial-hardships caused by lack of coverage of rehabilitation costs and unemployment in the low socioeconomic strata despite numerous health policies and schemes. These challenges prompt urgent research in the health system and open opportunities for strategic-planning of context-specific, participatory, sustainable, climate-resilient measures to rebuild lives and facilitate respectful integration in society and alleviation of socio-economic burden of SCI.
中低收入国家（LMICs）三级医疗保健机构中脊髓损伤（SCI）患者的康复情况正在改善。然而，康复及融入社区仍是一个遥远的目标。
患者报告的康复及社区融入方面的挑战有哪些，这些挑战为改变脊髓损伤患者的生活带来了机遇。
对24名成年脊髓损伤患者的临床记录和访谈进行分析，以报告社会人口统计学信息、功能状况、残疾情况、护理费用、健康相关生活质量及环境障碍。
50%的个体属于中低社会经济阶层。受伤7.8年后，功能独立性（SCIM）在室内最高（9.0±1.4）；在户外移动方面最低（9.3±4.0）。低收入阶层的个体无法使用室内供水设施（n = 5）和厕所设施（n = 8）。世界卫生组织生活质量量表（WHO-QoL）在环境领域得分最低（39.5±15.0）。70%脊髓损伤前就业的个体无法回到原工作岗位。受伤后，8人从事替代性低薪工作；而16人依赖家庭。护理费用由个人（n = 1）、政府医疗保险（n = 1）、私人医疗保险（n = 3）、雇主（n = 5）、非政府组织（n = 2）、家庭（n = 12）支付。
患者报告的脊髓损伤个体康复及社区融入方面的挑战，凸显了住房基本设施获取、交通及公共空间不便以及低社会经济阶层因康复费用无保障和失业导致的经济困难等方面的差距。尽管有众多卫生政策与计划，但这些挑战促使对卫生系统进行紧急研究，并为制定因地制宜、参与性、可持续、适应气候变化的战略措施提供了机遇，以重建生活、促进体面融入社会并减轻脊髓损伤的社会经济负担。
