Perceived Barriers and Facilitators to Community Reintegration after Spinal Cord Injury: A Critical Review of the Literature

A spinal cord injury (SCI) significantly affects an individual's return to and participation in community living. The goal of SCI rehabilitation is to enable an individual to reintegrate into community life; however, limited knowledge exists regarding the variables that facilitate or impede community reintegration. Among existing studies, few have been critically appraised to evaluate the quality of evidence. The review objectives are 3-fold: (1) to critically appraise the recently published literature regarding community integration for people with spinal cord injury; (2) to summarize the best evidence with a goal of translating knowledge into clinical practice; and (3) to provide recommendations for how the field can best be advanced in the most scientifically rigorous manner. Of the articles reviewed, 31 met specific inclusion criteria; 8 were of high methodological quality and 23 were of moderate to low methodological quality. Most of the reviewed articles were classified as level III (moderate evidence). Barriers to community reintegration included pain, inaccessible environments, financial constraints, and poor health. Facilitators included social support, internal locus of control, employment, and accessible transportation and housing. This article highlights the need for further well-designed studies to contribute to the understanding of community reintegration and facilitate the translation of knowledge to inform best practice guidelines in SCI rehabilitation.