Development of community participation indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

The Journal of Spinal Cord Medicine, 2021 · DOI: 10.1080/10790268.2021.1955204 · Published: January 1, 2021

Spinal Cord Injury Rehabilitation Public Health

Simple Explanation

This research focuses on improving the quality of rehabilitation for people with spinal cord injuries (SCI/D) to help them participate more fully in their communities. The SCI-High Project developed indicators to measure structure, process, and outcomes related to community participation within the first 18 months after rehabilitation admission. A working group of experts defined community participation and reviewed existing research to identify factors that influence participation. They created a diagram to visually represent these factors and then selected specific indicators to track progress and improvement. The selected indicators include the availability of transition living settings, therapeutic community outings, weekend passes home, and measures of self-efficacy and reintegration into normal life. These indicators aim to inform whether rehabilitation programs are effectively improving community participation for individuals with SCI/D.

Study Duration

30 months

Participants

N = 13 diverse stakeholders including practitioners, physiatrists, community organization partners, policy leaders, rehabilitation scientists, researchers and a stakeholder with lived experience.

Evidence Level

Not specified

Key Findings

1
The study identified a structure indicator: the proportion of SCI/D rehabilitation programs with availability of a transition living setting/independent living unit.
2
The process indicators included the proportion of SCI/D rehabilitation inpatients who experienced: (a) a therapeutic community outing prior to rehabilitation discharge; and, (b) those who received a pass to go home for the weekend.
3
The intermediary and final outcome measures are the Moorong Self-Efficacy Scale and the Reintegration to Normal Living Index.

Research Summary

The SCI-High Project developed a set of indicators to assess and improve community participation for adults with spinal cord injuries (SCI/D) within 18 months post-rehabilitation admission. This project addresses the challenges individuals with SCI/D face in transitioning from inpatient care to community life. A pan-Canadian working group defined community participation, reviewed existing research, and created a Driver diagram to identify key factors influencing community participation. This led to the selection of structure, process, and outcome indicators. The selected indicators aim to measure the availability of transition living units, the frequency of therapeutic community outings and weekend passes, and the levels of self-efficacy and reintegration into normal living among individuals with SCI/D. These indicators are intended to promote better rehabilitation practices and enable greater community participation post-discharge.

Practical Implications

Quality Improvement

The indicators can be used by rehabilitation programs to identify areas for improvement in supporting community participation for individuals with SCI/D.

Policy Development

The indicators can inform policy decisions related to resource allocation and service delivery for SCI/D rehabilitation.

Research Advancement

Longitudinal data collected using these indicators can be used to advance research on the factors influencing community participation and the effectiveness of rehabilitation interventions.

Study Limitations

1
The indicators have not yet been piloted.
2
The Working Group lacked a stakeholder perspective from family caregivers.
3
Geographic discrepancies across Canadian rehabilitation sites may require more flexibility on how the structure and/or process indicators are recorded.

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