This study contributes to the evidence base regarding outcomes following SCI. Enabling engagement in meaningful activities in the community must be at the forefront of occupational therapy intervention, both at an individual client level and through advocacy and policy involvement, to improve the quality of life of people with SCI living in the community.

Evaluation of rehabilitation outcomes following acquired disability should include participation in social and community life. Evidence is needed to guide clinical practice to ensure that it is client-centered; therefore, findings from studies that report on social and community participation following spinal cord injury (SCI) need to be reviewed and synthesized. The objectives of this critical literature review are to examine the available evidence on social and community participation following SCI and to examine the factors that influence that participation. The barriers and facilitators will be identified and described in terms of the contextual factors - personal or environmental, as outlined by the International Classification of Functioning, Disability and Health. An additional objective is to appraise the quality of the evidence examined. A systematic literature search was completed in the databases OVID MEDLINE, AMED, CINAHL PLUS, PSYCHINFO, and hand searches were carried out. Quantitative, qualitative, and mixed methods studies were included. Twenty-three studies fulfilled the inclusion criteria: 17 quantitative, five qualitative, and one mixed methods. In general, studies were of low methodological quality, and no intervention studies were identified. The terms participation, social participation, and community participation were used interchangeably often without clarification of meaning. Adequate personal care assistance, appropriate social support, having adequate specialized equipment, and appropriate occupational therapy input were found to facilitate social and community participation, whereas problems with transport, inaccessibility of the natural and built environment, issues with healthcare services and rehabilitation providers, and pain were identified as barriers. In-depth investigation into what aspects of social and community participation are important to those living with SCI is needed so that client-focused solutions and interventions can be identified and developed, aimed at creating and promoting opportunities for social and community participation.

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Introduction: The number of people with non-traumatic spinal cord injury is rising in developed countries such as Australia and Great Britain. People with non-traumatic spinal cord have different gender, injury and age-related profiles compared to those with traumatically acquired spinal cord injury; therefore, their lived experience is likely to be different. However, the specific issues and challenges that this group faces have not been well investigated. Method: Semi-structured in-depth interviews were conducted with 17 adults with non-traumatic spinal cord injury. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Findings: The factors that influenced the social and community participation of people with non-traumatic spinal cord injury were grouped into three broad areas: person factors, factors in the physical and institutional environment, and factors in the social or cultural environment. Conclusion: The findings from this study inform the understanding of occupational therapists regarding the social and community participation of people with non-traumatic spinal cord injury and how this can be facilitated. Assisting people with non-traumatic spinal cord injury to participate in meaningful social and community-based activities is important to maximise their quality of life.

By using a qualitative approach, this study adds to the understanding of the adjustment process experienced by people following non-traumatic spinal cord injury when they return to living in the community. Although findings parallel those of studies conducted with people with TSCI, there are some differences that may warrant alternative approaches from occupational therapists working with people with NTSCI. Such approaches include assisting people with NTSCI to modify their expectations regarding how they will participate in the community, assisting them to find new meaningful roles, and facilitating the development of new social networks to replace lost ones.