Facilitators and barriers in the rehabilitation process described by persons with spinal cord injury: a deductive-inductive analysis from Finnish Spinal Cord Injury Study

Abstract

Background A spinal cord injury (SCI) has multiple effects on the persons’ life, and can lead to impairments in activities, social participation, and environmental factors. Rehabilitation is important for regaining functioning and new skills. The aim of the study wasto determine the factors that people with SCI perceived as promoting and facilitating their rehabilitation, and what they found to be challenges and possible barriers. Methods This study was part of a larger, mixed method Finnish Spinal Cord Injury study (FinSCI). The current study had a qualitative approach and used a deductive-inductive content analysis. The deductive approach was guided by a theory of six phases of a rehabilitation process by Autti-Rämö, followed by an inductive analysis to describe in-depth the perceptions of persons with SCI in each phase of the rehabilitation process. We collected the data by interviews from 45 persons representing participants from FinSCI study and used a structured interview guide. Results We found 28 facilitators and 19 barriers in the rehabilitation process. The majority of the facilitators and barriers were related to the phase of rehabilitation planning. There were more barriers than facilitators at the beginning of the rehabilitation process in applying for and accessing treatment or rehabilitation, and during the implementation of rehabilitation. As for the facilitators that progressed the rehabilitation process, some of them included: successful or realized, planned treatments, rehabilitation events, clear goals, multidisciplinary teamwork, support, and monitoring various changing situations, and rehabilitating one’s own capability and activity. The barriers were: delays, challenges and deficiencies in the planning and implementation of their treatment or rehabilitation, the lack of different rehabilitation professionals’ skills and resources, and different patients’ personal factors, which made the progress of the rehabilitation process cumbersome. Conclusions We identified that communication and interaction were common denominators for the facilitators and barriers. Good communication and interaction among rehabilitation professionals and rehabilitees promoted the occurrence and repetition of facilitating factors during different phases of the rehabilitation process. Good care and good rehabilitation practice for people with SCI were the result of multidisciplinary teamwork, in which a person with SCI was an active member.