Strengthening Health Systems for Persons With Traumatic Spinal Cord Injury in South Africa and Sweden: A Protocol for a Longitudinal Study of Processes and Outcomes

Abstract

Background: The provision of specialized care in a time-sensitive manner has shown to be crucial for survival and recovery of functioning after a traumatic spinal cord injury (TSCI). However, little is known about the provision of TSCI care in different international contexts; information which is required for strengthening policy and practice.Aims: The overarching aim of this study will be to explore health care processes and outcomes of TSCI care in South Africa and Sweden. Specific aims will be to: (1) describe acute processes of TSCI care, (2) determine acute- and long-term outcomes of TSCI care, and (3) identify predictors for survival, secondary complications, and functioning 12 months post-injury.Methods: A prospective (regional), population-based cohort study where adults with an acute TSCI will be recruited over at least a 1-year period from the City of Cape Town, South Africa, and Stockholm, Sweden. The anticipated sample size inclusive of both international contexts will be 200 participants—based on a power calculation for detecting differences in mortality. Information on the nature and timing of processes of acute care (e.g., transfer logistics, spinal surgery, and specialized SCI care) will be collected on acute care admission and discharge using a standardized form. Survival status, secondary complications, neurological symptoms, functional status, activity, and participation as well as health-related quality of life will be collected at discharge from SCI acute care and at 12-months post-injury. Secondary complications and functioning will be compared between South Africa and Sweden using inferential statistics. To address mortality specifically, the indirect standardization method for differences in mortality between contexts will be used whereby Stockholm will serve as standard for specialize care. For the assessment of factors related to mortality and other outcomes (e.g., neurological and secondary health conditions) multivariate regression analyses will be used to determine independent risk factors.Conclusion: This study offers a unique investigation of the relationship between health care processes and outcomes of TSCI care with the aim of strengthening management guidelines for SCI in South Africa and Sweden.

How Can Policymakers be Encouraged to Support People With Spinal Cord Injury—Scoping Review

“…The findings of this study are high-quality evidence for policymakers to assess the feasibility and cost-effectiveness of life-saving changes in health care processes of SCI patients. 5 …”

“… 7 , 16 , 21 There is a lack of accessible resources and essential epidemiological data and statistics, as well as a lack of identifying the unmet needs, of SCI patients in developing countries. 5 Epidemiological data and information on the needs of individuals with SCI are useful for policymakers and could be used to improve health care policies. A patient registry is an organized collecting data system that is used for scientific, clinical, or policy purposes.…”

“…High-quality research can positively impact health policy. 5 Noonan et al: 2012 17 To present developing a model…”

“…The activities of these organizations have raised the attention of people and governments. 14 Conradsson et al: 2018 5 prospective cohort study There is a significant gap of knowledge regarding the nature of traumatic SCI care in low-tomiddle income countries.…”

“…For this reason, the process of policymaking and legislation must be modified. [4][5][6] To improve health system services and reduce health deficiencies, policymakers need to find the best solutions for health problems and the best ways to elicit the desired changes in health systems. Policymakers must understand the beliefs and behaviors related to most of the target population to create appropriate laws.…”