Patient-reported challenges in spinal cord injury rehabilitation and integration within the community of a lower middle-income country: opportunities for changing lives

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. • The study reports challenges in community integration faced by individuals with spinal cord injury largely from low socio-economic strata of a lower middle-income country 8 years after injury. • Present findings prompt an urgent need for health policy and system research in rehabilitation to enhance effective implementation and coverage of policies. • Opportunities for sustainable, accessible, climate-resilient infrastructure development and insurance coverage of rehabilitation costs are presented to rebuild lives of individuals with spinal cord injury.