Exploring the contextual transition from spinal cord injury rehabilitation to the home environment: a qualitative study

Abstract

Study design Explorative qualitative study based on an interpretative phenomenological approach. Objectives This study explored the possibility of transferring knowledge and skills from a spinal cord injury (SCI) unit to the home environment; the individual and structural factors that potentially influenced this transfer; and its compatibility with a meaningful everyday life. Setting Hospital-based rehabilitation unit and community in Denmark. Methods Fourteen individuals with SCI were selected with maximum variation according to age, sex, marital status, and level of injury. In-depth, semi-structured interviews were conducted in the participants’ homes, 2–10 months after discharge from an SCI unit. Data analysis involved taking an interpretative phenomenological approach combined with a template analysis and applying the transfer of training theory to the discussion. Results Transitioning from the SCI unit to the home environment involved a multidimensional change of context in which most of the participants’ previous life roles had changed. This overarching theme had a decisive influence on: balancing loss and acceptance, facing external structural barriers, and the strength of social relationships when the knowledge and skills acquired at the unit were applied in a meaningful everyday life. Conclusions Transition from the SCI unit to the home environment is influenced by a multidimensional change of context that may restrict the use of acquired skills post-discharge, provide distant prospects for tertiary health promotion, and aggravate the experience of loss in people with SCI. Maintaining relationships is a strong mediator for transferring skills and re-establishing a meaningful everyday life.

Psychosocial Consequences of Spinal Cord Injury: A Narrative Review

“…Feeling any form of stigma can affect psychosocial outcomes such as social disconnection [ 23 ], a sense of injustice [ 12 ], greater depressive symptoms, reduced self-efficacy, and decreased quality of life [ 19 ]. Living with SCI is complicated, and stigma and bias are only one of several enduring psychosocial consequences a person experiences following SCI [ 21 ].…”

“…Living with SCI often forces individuals to re-evaluate and re-construct their personal and social goals and identities in their family and social systems as a result of transitioning to more dependent-functioning and changes in emotional, psychological, economic, environmental, and social stressors [ 12 , 23 , 25 , 30 , 31 , 32 ]. Such physical limitations of SCI may initially disrupt the original way in which spouses or family members interact or meet traditional expectations [ 2 , 12 , 33 ].…”

“…Living with SCI often forces individuals to re-evaluate and re-construct their personal and social goals and identities in their family and social systems as a result of transitioning to more dependent-functioning and changes in emotional, psychological, economic, environmental, and social stressors [ 12 , 23 , 25 , 30 , 31 , 32 ]. Such physical limitations of SCI may initially disrupt the original way in which spouses or family members interact or meet traditional expectations [ 2 , 12 , 33 ]. Despite these new and challenging stressors, individuals with SCI and their family members can better adapt to life with SCI by learning to accept the disability, staying solution focused [ 34 , 35 ], accentuate abilities and values [ 24 ], and utilize socialization and supportive communication [ 25 , 31 , 32 ].…”

“…Philosophically, this model helps others appreciate a person’s experience of medical issues by considering the dynamic interactions of physiological factors (bio) with the psychological and personal (psycho) and societal components (social). From a practical standpoint, the biopsychosocial model expands the standard medical model enabling multiple disciplines to approach the multifaceted components of the “person” and “social environment” [ 12 ] that directly affect subjective wellbeing and overall outcomes in the context of medical problems. For example, problems with mood, relationships, or personal sense of meaning can result in maladaptive behaviors [ 13 ] (e.g., alcohol misuse) that can cascade into further physical, social, and functional impairments, compounding challenges in an already difficult circumstance.…”

Current Approaches in Telehealth and Telerehabilitation for Spinal Cord Injury (TeleSCI)

“…After discharge from inpatient rehabilitation, the first several weeks at home following an SCI are challenging for most patients and their families. In addition to psychosocial adjustment, they usually encounter numerous unexpected challenges that can compound the stress of transition [ 66 ]. However, living away from urban centers where specialty care is often centered usually results in lower service utilization [ 40 ].…”