The Influence of the Inpatient Rehabilitation Experience on the Transition to Home Among People with Spinal Cord Injury in South Africa: A Qualitative Study

Abstract

Background: Spinal cord injury (SCI) can have a significant impact on a person’s ability to self- manage, engage in home life, and participate in community activities. The purpose of rehabilitation following SCI is to empower patients to optimize their ability to do these activities. The experience of inpatient rehabilitation can impact the transition back to home and to the community. However, studies looking at the experience of inpatient rehabilitation in low-middle income countries are scarce. Thus, the aim of this study was to explore how the experience of inpatient rehabilitation following SCI influences the transition to home. Methods: This was a qualitative study which used an explorative design. Eleven participants were included in the study, and data was collected using semi-structured interviews. Participants were interviewed within their last week of inpatient rehabilitation in a spinal unit in a private rehabilitation hospital. Interviews were transcribed verbatim, and we used inductive analysis to identify the themes and categories. Results: Most of the participants in the study were male, had incomplete spinal cord injuries, and thoracic-level injuries. The themes which emerged from the interviews were overall rehabilitation experience was good,” “factors influencing rehabilitation experience” and “unmet care needs influencing readiness for transition to home.” The environmental factors which influenced the experience of rehabilitation and the transition to home included the attitude of the health staff, physical space, and care approach. The personal factors included emotions and beliefs. The unmet needs included closing the gap between skills acquired and skills practiced, the physical environment to simulate the home environment, formal and individualized psychological support, and for patients to be involved in decision-making. Conclusion: Although the inpatient rehabilitation was good and some patients felt prepared to go home, there are multiple factors which influence the transition to home as well. 5 Rehabilitation units should take these factors into consideration when developing rehabilitation programmes and training rehabilitation staff to provide specialized, patient-centred SCI care.