Health profiles, environmental barriers, and functional outcomes among individuals with spinal cord injury in Lebanon: A cross-sectional study

CONTEXT/OBJECTIVE: Spinal cord injury (SCI) in Lebanon represents a major public health challenge compounded by prolonged economic collapse, healthcare fragmentation, and conflict-related instability. In the absence of a national SCI registry, this study aimed to characterize health status, environmental barriers, functioning, and quality of life (QoL) of individuals living with SCI in Lebanon using the internationally standardized International spinal cord injury (InSCI) framework. DESIGN: Cross-sectional survey study. SETTING: Community and rehabilitation settings across five Lebanese governorates. PARTICIPANTS: A total of 81 adults with chronic SCI were recruited between March and October 2025 through purposive convenience sampling. The sample was predominantly male (77.1%), with a mean age of 39.7 years; 68.7% had paraplegia. INTERVENTIONS: Not applicable. OUTCOME MEASURES: Data were collected using the Leb-InSCI questionnaire, a culturally adapted instrument based on the International SCI Survey and the WHO International Classification of Functioning, Disability, and Health (ICF). Measures included the SCI Secondary Condition Scale (SCI-SCS), Self-Report Spinal Cord Independence Measure (SCIM-III), Short Form Nottwil Environmental Factors Inventory (NEFI-SF), InSCI Mental Health and Vitality items, EQ-5D-5L, and SF-36 Health Survey. RESULTS: A substantial treatment gap for secondary complications was identified. Chronic pain (53.6%) and spasticity (34.5%) were highly prevalent, yet 88.1% and 50.0% of affected individuals, respectively, reported receiving no clinical intervention. Environmental barriers were pervasive, with 58.4% reporting extreme difficulty using public transportation and more than half identifying inaccessible infrastructure as a major restriction to community participation. Marked vocational exclusion was also observed, as only 19.8% were engaged in paid employment despite approximately 60% expressing willingness to work. Physical health-related QoL scores were low (SF-36 Physical Component Summary: 32.02), whereas comparatively higher mental health scores (44.97) suggested relative psychological resilience, potentially supported by family networks. CONCLUSION: Individuals with SCI in Lebanon experience persistent unmet healthcare needs, environmental exclusion, and socioeconomic marginalization. These findings highlight the urgent need for specialized multidisciplinary rehabilitation services, improved access to treatment for secondary conditions, enforcement of accessibility and universal design policies, and inclusive employment strategies to support long-term community reintegration and quality of life.