Dyadic coping among couples affected by spinal cord injury: a qualitative systematic review and meta-synthesis

Spinal cord injury (SCI) affects injured persons as well as their intimate partners, whether married or cohabiting. Partners often take on practical care, and qualitative studies describe how couples negotiate these caregiving roles. Dyadic coping describes how couples respond together to shared stress. Qualitative studies have examined couples’ experiences after SCI, but they tend to report one perspective, one domain or one stage of recovery, and to describe findings in different conceptual vocabularies, which makes them difficult to place alongside one another. Eleven databases (the Cochrane Library, PubMed, Embase, Web of Science, CINAHL, Scopus, PsycINFO, CNKI, WanFang, VIP and CBM) were searched from inception to 5 April 2026. In accordance with a protocol registered on 31 March 2026 (PROSPERO CRD420261356751), two reviewers independently selected studies, extracted data and appraised methodological quality using the JBI Critical Appraisal Checklist for Qualitative Research. Confidence in each category was assessed with GRADE-CERQual. An aggregative qualitative meta-synthesis was conducted. Eleven studies from seven countries were included. Forty findings were organized into 12 categories and four synthesized findings, presented as themes: (1) an adaptation trajectory typically described from acute shock through inpatient rehabilitation and post-discharge crisis to long-term reconstruction, with overlap and returns rather than a single onward path; (2) relational processes involving identity renegotiation, role and boundary negotiation, and intimacy redefinition; (3) protective and co-creative dyadic coping tasks that often occurred together; and (4) contextual facilitators and barriers related to relationship resources, service engagement, gender norms, stigma and structural hardship. CERQual confidence was mostly moderate, with high confidence for one category (redefining intimacy). Couples’ adjustment to SCI was described across successive recovery settings from injury through hospital, return home and later life, rather than as steady improvement. Movement along this course often overlapped or reversed rather than proceeding in a single direction. The findings suggest that couple-centred rehabilitation nursing should consider both partners’ changing needs over time, particularly during transitions from hospital to home and longer-term adjustment.