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

Abstract

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.

Effectiveness of Telerehabilitation in Persons With Spinal Cord Injury During the COVID-19 Pandemic (TELE-SCOPE): A Single-Center, Double-Blind, Randomized Controlled Trial

“…The specific nature of the intervention may have contributed to preventing or minimizing the occurrence of these complications, thus demonstrating its effectiveness in promoting better health outcomes. The findings from our study also corroborate the existing literature [ 16 , 17 ]. Recent systematic reviews and meta-analyses also revealed that, though telerehabilitation is found to improve certain domains of neurological disorders, it needs more evidence [ 18 ].…”

Understanding barriers to spinal cord injury rehabilitation services in Nepal: A qualitative study of rehabilitation professionals’ perspectives.

“…Nepal has consistently faced financial hardship as the most critical barrier to health care services, including rehabilitation (Shah et al, 2013). Other key barriers to rehabilitation in Nepal include challenging topography, limited availability of transportation facilities (Baniya et al, 2023), limited knowledge related to rehabilitation among the public, and a shortage of rehabilitation professionals (Shah et al, 2013). Similarly, the political turmoil of the nation might have kept the development of rehabilitation policies at bay.…”