Models of Care Delivery from Rehabilitation to Community for Spinal Cord Injury: A Scoping Review

Abstract

Spinal cord injury (SCI) is a chronic condition that results in high healthcare utilization and lifetime cost across the care continuum. In the absence of a standardized model of care delivery for SCI in western countries such as Canada, a scoping review of the literature was performed to identify and summarize existing international SCI models of care delivery. Four databases were searched using key words and subject headings for concepts such as: ''spinal cord injury,'' ''delivery of healthcare,'' ''model of care,'' ''patient care planning,'' and ''care pathway.'' Title, abstract, and full text review were competed by two independent reviewers. A combined total of 46 peer-reviewed and gray literature articles were included. No single SCI model of care has been adopted across different countries internationally. However, optimal attributes of models of care were identified, including the importance of having multidisciplinary SCI specialty care providers along the continuum, provision of rural SCI services and outreach, integration of primary care, peer mentoring, and using a hub and spokes model of care. These findings inform the future development of an SCI model of care, which ideally would serve all geographical locations and span the continuum of care, improving the health status and quality of life of persons with SCI.

Functional recovery priorities and community rehabilitation service preferences of spinal cord injury individuals and caregivers of Chinese ethnicity and cultural background

“…For countries with lower incomes and financial resources, they may need to use an affordable low-cost and low-technology approach to achieve adequate care of SCI individuals ( 23 , 24 ). Similar discrepancies are present in the provision of community rehabilitation after the stay in SCI rehabilitation units across different countries ( 25 ). Since there is a lack of information of service users' experience locally, we would also like to investigate their preference on current service and potential areas of service enhancement.…”

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

“…TeleSCI can expand access to care for rural patients by providing access to SCI expertise without traveling long distances to be seen [ 26 – 28 ]. It can supplement in-person care for those with complex sacral wounds by reducing the number of visits that require complex transportation planning [ 24 , 29 , 30 ].…”

“…Similarly, for those with low technology literacy and/or comfort, hesitancy may further compound difficulties where structural barriers (e.g., lack of adaptive equipment, caregiver support, or poor broadband infrastructure) already exist [ 28 ]. Some mitigating forces include using adaptive equipment [ 39 ], increasing broadband infrastructure, provision of iPads to patients without internet-enabled devices [ 19 ], and creating clinic-to-clinic agreements in rural communities to extend SCI specialty care in under-resourced areas [ 26 , 32 , 40 ].…”

Optimizing spinal cord injury care in Canada: Development of a framework for strategy and action

“…In Canada, more than 86,000 people are affected by spinal cord injuries, from either a traumatic (e.g., fall) or non-traumatic cause (e.g., tumor) ( 11 ). SCI is a life-altering condition that significantly impacts one's daily life, physical and emotional health, and quality of life ( 9 ). Following an SCI, individuals require comprehensive care and support to maximize recovery and resume meaningful participation in everyday occupations and activities of daily living ( 12 ).…”

“…Model of care/care pathway: Pathways by which health care services are systematically delivered ( 9 ).…”