The Experience of Limited Access to Care for Community-Based Patients With Spinal Cord Injury and Stroke in Nepal and the Potential of Telerehabilitation: A Qualitative Study.

This study explores the experiences of care received and management of disability for individuals with spinal cord injury and stroke following discharge from a specialty rehabilitation center, alongside perspectives on the potential role of telerehabilitation. We employed qualitative in-depth face-to-face interviews with patients who had accessed and been discharged from a specialist rehabilitation center in Nepal were used. Interviews sought perspectives of adjusting to, living with, and managing disability alongside the potential role of telerehabilitation in the community setting. Inductive thematic analysis was used to derive themes. A total of 17 participants with spinal cord injuries or stroke were interviewed. Four generated themes included: (i) Difficulties accessing support and perceived mismanagement following initial neurological injury; (ii) Realizing the magnitude and impact of an injury in the absence of clear routes to support; (iii) A multi-faceted symptom burden and its impact; and (iv) The nature and types of interaction with health professionals post-discharge and the potential role of telerehabilitation. We detail accounts of suspended periods with minimal or no support provided from healthcare providers for people with spinal cord injury and stroke following initial acute management. Telerehabilitation could be a worthwhile approach to enhance access to rehabilitation in the community setting but must accompany national efforts to enhance the provision of specialist rehabilitation.

TEleRehabilitation Nepal (TERN) for People With Spinal Cord Injury and Acquired Brain Injury: A Feasibility Study.

BACKGROUND: Spinal Cord Injury (SCI) or Acquired Brain Injury (ABI) leads to disability, unemployment, loss of income, decreased quality of life and increased mortality. The impact is worse in Low-and Middle-Income Countries (LMICs) due to a lack of efficient long-term rehabilitative care. This study aims to explore the feasibility and acceptability of a telerehabilitation programme in Nepal. METHODS: Prospective cohort feasibility study in a community setting following discharge from a specialist rehabilitation centre in Nepal. Patients with SCI or ABI who had previously accessed specialist rehabilitation were connected to a specialist Multidisciplinary Team (MDT) in the centre through a video conference system for comprehensive remote assessments and virtual individualised interventions. Data were captured on recruitment, non-participation rates, retention, acceptability (via end-of-study in-depth interviews with a subset of participants) and outcome measures including the Modified Barthel Index (MBI), Depression Anxiety Stress Scale (DASS) and EuroQol-5D (EQ-5D), completed pre- and post-programme. RESULTS: 97 participants with SCI (n = 82) or ABI (n = 15) discharged from the centre during an 18-month period were approached and enrolled on the study. The telerehabilitation programme facilitated the delivery of support around multiple aspects of rehabilitation care, such as spasticity treatments and pain management. Outcome measures indicated a significant improvement in functional independence (P < .001), depression, anxiety and stress (P < .001) and quality of life (P < .001). Qualitative interviews (n = 18) revealed participants found the programme acceptable, valuing regular contact and input from MDT professionals and avoiding expensive and lengthy travel. CONCLUSION: This is the first study in Nepal to identify telerehabilitation as a feasible and acceptable approach to augment the provision of specialist rehabilitation. Future research is needed to assess the suitability of the programme for other conditions requiring specialist rehabilitation and determine the mechanisms underpinning improved outcomes for people with SCI or ABI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04914650.

Level of Exercise Participation in Individuals with Traumatic Spinal Cord Injury During Inpatient Rehabilitation: A Cross-sectional Study.

BACKGROUND: The outcome of exercises depends on participants' level of exercise participation. We aimed to investigate the level of exercise participation in individuals with traumatic spinal cord injury during inpatient rehabilitation. METHODS: All participants with traumatic spinal cord injury undergoing inpatient physiotherapy at a rehabilitation center were recruited. Participants with hearing/visual problems were excluded. Hopkins Rehabilitation Engagement Rating Scale and Pittsburgh Rehabilitation Participation Scale were used to evaluate exercise participation levels. One-way ANOVA and unpaired t-test were used to compare level of participation between groups. Pearson's correlation and Chi-square tests were used to evaluate correlation and association. RESULTS: Thirty-five participants with mean age 37.1 ± 11.7 years completed the study. Hopkins Rehabilitation Engagement Rating Scale and Pittsburgh Rehabilitation Participation Scale demonstrated a low level of exercise participation in 31.4 % and 42.9 % participants respectively. Participants with an incomplete injury had high exercise participation levels compared to complete injuries. There were significant group differences (p < 0.001, effect size = 0.8) between complete and incomplete injuries and among various levels of injuries. The level of exercise participation was significantly associated with injury levels and type (p < 0.001, Phi = 0.7 to 0.9). CONCLUSIONS: The exercise participation level was high for incomplete compared to complete injuries in Nepalese individuals with traumatic spinal cord injury. The demographic and socio-economical factors were not associated with level of exercise participation.

Factors influencing depression in individuals with traumatic spinal cord injury and caregivers' perceived burden in a low-income country: a cross-sectional study.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To investigate factors influencing depressed mood in individuals with traumatic spinal cord injury (TSCI) and caregivers' perceived burden in a low-income country. SETTING: Dhulikhel Hospital and Spinal Injury Rehabilitation Center, Nepal. METHODS: We recruited 95 couples (one person with spinal cord injury and one caregiver) aged 18-65 years. Participants with various levels and types of TSCI with post-injury duration of or providing care for ≥1 month were eligible for the study. The Nepali Beck Depression Inventory and the Zarit Burden Interview-12 were used to identify depressed mood of those with TSCI and caregivers burden, respectively. Linear regression analyses to explore associations was performed. RESULTS: Mean ages of the individuals with TSCI and caregivers were 34.8 (11.0) and 33.6 (12.3) years, respectively. Most of the participants with TSCI were male (67.4%) and (73.7%) had paraplegia. The caregivers were predominantly female (61.1%). Depressed mood was seen in 68% of those with TSCI, and burden was reported by 91.6% of caregivers. Depressed mood was significantly associated with gender, education, lesion type, and duration since the injury. Caregiver burden was associated with occupation, education, level of injury, length of care, and depressed mood level in the person with TSCI. Economic burden was found to be the highest (71.5%) followed by responsibility (22.2%) and time-related (6.3%) burden. CONCLUSIONS: The prevalence of depressed mood among individuals with TSCI and the burden of caregiving among caregivers was high. Depressed mood in those with TSCI was associated with caregiver burden. Country-specific contextual factors need to be considered in deriving rehabilitation protocols.