Why Is Family Education Important for Spinal Cord Injury

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Peer-reviewed

Inquiry Article

Barriers and facilitators of teaching provided during rehabilitation of people with spinal cord injuries: A qualitative clarification

• Alessio Conti,
• Valerio Dimonte,
• Antonella Rizzi,
• Marco Clari,
• Silvia Mozzone,
• Lorenza Garrino,
• Sara Campagna,
• Alberto Borraccino

x

• Published: October 15, 2020
• https://doi.org/10.1371/journal.pone.0240600

Figures

Abstract

Background

Afterward a spinal cord injury (SCI), individuals must acquire their maximum level of independence earlier returning to their previous social and working weather condition. The education provided during rehabilitation is one of the basic but complex aspects that influence the wellness perspectives of people with SCI. Gaining the perspective of SCI survivors experienced barriers and resources to enhance the education process may assist healthcare professionals in agreement this complex aspect of their exercise. Through a qualitative descriptive assay, this written report aimed to identify the perceived barriers and facilitators of teaching provided during the rehabilitation of individuals with SCI.

Methods

A purposive sample of 22 adults with SCI and at least six months of home feel was recruited. Participants were assigned into four mini focus groups co-ordinate to their level of independence. The focus groups were audio-recorded, transcribed verbatim, and analysed using a thematic analysis.

Results

Three themes were identified: the readiness to education, the private characteristics, and the environmental and social characteristics influencing education. Participants perceived didactics to be an ongoing process made upwards of consecutive phases, each of which had to be overcome before participants felt gear up to reappraise their health and well-existence. This procedure was affected past private, ecology, and social factors.

Conclusions

Education is constantly provided by all members of the rehabilitation team. These must stress the relevance of the contents presented, increase SCI survivors' motivation to ready achievable goals, and consider filling the gap that the patients perceive between rehabilitation centres and available community resource. The findings of this study promote the blueprint of structured educational programmes, increasing cognition, and improve the health perspective of SCI survivors, their families, and providers.

Citation: Conti A, Dimonte V, Rizzi A, Clari Thou, Mozzone S, Garrino 50, et al. (2020) Barriers and facilitators of education provided during rehabilitation of people with spinal string injuries: A qualitative description. PLoS I fifteen(x): e0240600. https://doi.org/10.1371/journal.pone.0240600

Editor: Rachel A. Annunziato, Fordham University, The states

Received: June 3, 2020; Accepted: September 29, 2020; Published: October 15, 2020

Copyright: © 2020 Conti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Information Availability: Since the data collected contain sensitive patient information that may be potentially identifying, the Ethics Commission of the Città della Salute e della Scienza di Torino, Mauriziano Hospital, ASL TO one disposed that data could be obtained and fabricated available upon reasonable request. The request should be sent to the corresponding author and be forwarded writing an email in carbon-copy to comitatoetico@cittadellasalute.to.it for the approval, specifying the Resolution number 105785/2016—#CS2/28. Information are available in the language in which interviews take been performed (Italian).

Funding: The authors received no specific funding for this work.

Competing interests: The authors have alleged that no competing interests exist.

Introduction

Spinal cord injury (SCI) is one of the most complex, debilitating health weather condition a man can suffer. More 500 000 people worldwide suffer a SCI annually, with severe consequences for the families of affected individuals and on many activities of daily living (ADL) [1]. The subsequent, and sudden loss of motor-sensory and autonomic neurologic functions [2] can lead to impairments and limitations in domestic, employment, and leisure activities, causing difficulties in the maintenance of and participation in social relationships [3]. These limitations tin reduce independence, affect long-term health and quality of life (QoL), increase the risk of secondary wellness weather condition, and increase the SCI bloodshed charge per unit compared to the general population [4, 5]. Moreover, challenges experienced by people with SCI, included those related to their lack of free energy due to their condition, might lead to adverse psychological outcomes, such as depression and loss of motivation [6]. All these factors accept direct and indirect effects on overall healthcare costs.

Rehabilitation following SCI is long and usually takes place in a dedicated rehabilitation centre. These facilities are staffed with healthcare professionals from different disciplines, who are responsible for helping those with SCI reacquire their independence and assume responsibility for their health [seven]. In fact, common issues that people with SCI experience when returning to their previous social and working weather condition are limited mobility, continence care, and sexuality. 1 of the primary components of SCI rehabilitation is education. Educational programmes are designed to teach patients to principal the self-management skills needed to perform ADL [eight]. Appropriate cocky-management involves a wide array of behaviours [9] aimed at improving QoL and reducing secondary wellness conditions, re-hospitalisation rates, and overall SCI bloodshed [10].

Although the discharge from the rehabilitation middle is followed past a critical stage, when individuals must adapt to the challenges of living with their disability [11], people with SCI are often discharged before they have mastered the necessary self-management skills. This due to the progressive turn down in length of stay in rehabilitation centres, shortage of staff, and skill-mix related issues [12]. Thus, practical, and toll-constructive strategies that can be implemented in educational programmes early on in the rehabilitation process need to exist identified [13]. Contempo studies showed conflicting evidence on the effectiveness of available educational programmes in improving patients' problem-solving skills, their noesis of the injury, self-management skills, and QoL [14, xv]. Several clinical and ecology factors have been associated with successful educational programmes in early rehabilitation; virtually are related to the perspectives that those with SCI take towards wellness, their access to such programmes and their engagement in the rehabilitation procedure [fifteen]. In lite of this, we must deepen our understanding of the educational experiences of individuals during the rehabilitation process to place perceived barriers and facilitators of educational programmes. We must too identify boosted resources that individuals with SCI perceive as useful to promote self-management skills and increase well-being. Hence, nosotros aimed to place the perceived barriers and facilitators of education during rehabilitation of individuals with SCI.

Materials and methods

Study design and participants

A qualitative descriptive design using mini focus groups (FGs) was called for this study [16]. A purposive sample of SCI survivors hospitalised and rehabilitated at the "Città della Salute due east della Scienza" Hospital of Turin was selected from the hospital's database to consider individuals who followed the same educational programme. To be eligible, patients had to: (i) take a diagnosis of SCI according to the international standard for neurological and functional classification (ASIA), (ii) be eighteen years or older, (3) have been discharged from the rehabilitation heart from half-dozen months to 5 years before the get-go of the study, and (iv) speak and understand Italian. Nursing home inpatients and people with cerebral impairments were excluded. Ethical approval from the Ethics Commission of the Città della Salute e della Scienza di Torino, Mauriziano Infirmary, ASL TO ane, Turin, Italy (Resolution n° 105785/2016—#CS2/28), was obtained.

30-ane eligible patients were identified and contacted past phone, invited to participate, and asked to written report their level of independence in ADL. In gild to create groups based on like private experiences [17], patients were assigned to FGs according to their cocky-reported level of independence: totally dependent (FG 1), partially dependent (FG 2), fully contained (FG 3), and ambulatory and fully independent (FG four). Although all 31 patients agreed to participate in the study, 9 were unable to take part for personal reasons. A terminal sample of 22 participants (Table one) attended the FGs and were included in the analysis: fifteen men and six women, mainly with paraplegia (due north = xiv; 64%), with a hateful age of 49 years (±15.4) and an average of 4.5 years (±1.7) since belch from the rehabilitation heart. The majority of the sample was in a relationship (n = xiv; 64%) and had a high school instruction (n = xvi; 73%). Eight participants had an agile social role (37%), while the majority of the remaining were unemployed (n = 6; 27%) or retired (n = 8; 37%). All participants were voluntary and informed about the study procedure. They provided a written informed consent before the start of each FG.

Procedures

FGs took place over 4 weeks (one FG per week) in September 2016 in a dedicated room at the "Città della Salute e della Scienza" Infirmary. To avert any influence on participants' discussion, a divide area of the hospital was fix to host caregivers during the FGs. All FGs were performed once and followed the aforementioned procedure: a short trigger moving-picture show was shown at the starting time to encourage give-and-take and a FG guide was used to lead the subsequent discussion (Tabular array 2). Participants were free to collaborate using their own names if they chose to. To maintain anonymity and confidentiality during data assay and reporting, a sequential number was assigned to each participant. An experienced moderator (AR) facilitated each FG. Two research assistants, with a background in SCI rehabilitation, were involved as silent observers to take detailed field notes [xviii]. All the research team did non have previous relationship with participants or were part of the hospital staff. Each FG lasted approximately 80 minutes and was audio-recorded and transcribed verbatim. Debriefings were conducted after every FG to synthesise observations and capture initial thoughts about the topics discussed.

Analysis

A thematic analysis arroyo [xix] was applied consistently with the following phases: familiarisation with the information, generation of initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report [19]. AR, Air-conditioning, and SM analysed inductively the whole prepare of data through an iterative procedure. Verbatim transcriptions of FGs were read individually, thoroughly, and repeatedly to let the researchers to familiarise themselves with information; coding was developed to create categories and abstractions. After this first step, the researchers met to compare obtained codes and arrange final categories, which were and so condensed into themes through discussion. Data drove and analysis tended to exist simultaneous, to inform subsequent FGs [20]. The analysis involved two other independent auditors (SC, AB), who farther reviewed categories, abstractions, and themes. Data saturation, divers as data back-up or the point at which no new themes or codes emerge from data, tin exist hypothetically achieved later on three FGs [21]. For this reason, iv FGs were conducted in this report. Credibility and dependability were ensured through the use of an audit trail, verbatim transcriptions, and member checking with a subsample of participants [22]. The whole analysis was conducted on verbatim transcriptions and meaningful quotations were translated into English. The study was carried out and reported according to the Consolidated Criteria for Reporting Qualitative Research [23].

Results

Three themes were identified: readiness to education, individual characteristics, and environmental and social characteristics influencing education (Fig 1). Pedagogy is an ongoing procedure made up of sequent phases starting with the SCI outcome then weaving through the acute, early rehabilitation, and discharge phases. In each phase, private, environmental, and social characteristics influenced participants' learning processes.

Readiness to education

Hospitalisation was the showtime, unavoidable step on the chronological path described to a higher place, and it characterises the acute phase post-obit the triggering event. Participants portrayed this every bit a phase of utter defoliation and distress, when they were overwhelmed by their circumstances and unprepared to receive, permit lonely sympathise, data nigh their status, regardless of how relevant this information might take been. Participants confirmed that throughout early rehabilitation, they received valuable information, merely they were non able to perceive its value at the fourth dimension. During the acute phase, they dealt with severe emotional distress and lack of willpower, which were amplified past the presence of hurting and the lack of physical strength.

I recall that at the beginning, in my catatonic land, I felt really stuck, I couldn't do anything. Then I learned some mechanisms [of self-management], I tested different strategies [of self-management], and I came to understand that what matters is that I still have a encephalon and I can withal think.

(p#12–FG3)

The achievement of a psychological rest has been described as a fundamental prerequisite to engage in any educational program, and participants could not make it at this residual without accepting that SCI introduced a permanent modify in their life. A life that, as they expressed, needed to be completely redefined. Indeed, participants recalled how their realisation and acceptance that they would not attain total torso recovery was slow and progressive, although necessary to motion to the side by side stage of a new self-awareness and trunk recognition.

The problem with people who remain in the wheelchair is that they continue with their life thinking that they tin can't do annihilation anymore. In the beginning, information technology happened to all of usa; then we managed to go up [from the wheelchair] and we saw some lite at the finish of the tunnel again, but …in the beginning, if you tin't get up and you're depressed and in a wheelchair, you don't know if recovery is possible, considering the doctors can't tell y'all (…) Then, you have to decide to learn how to apply the wheelchair.

(p#21–FG4)

Beyond the awareness of their new, difficult situation, participants reported feeling continuous pressure level to learn numerous data and skills, in add-on to following a wide array of all-important recommendations. This pressure negatively impacted their already depression energy reserves which represented a farther barrier to education and their ability to understand their doctors' advice and priorities. Participants agreed that clear goal-planning during rehabilitation is every bit a resources to help deal with the effort required to prioritise and apply the data caused. Moreover, they agreed that the information they were provided with during rehabilitation could be fully understood simply after they had spent fourth dimension at home.

You lot tin can't wait that after a year of rehabilitation you will exit [the rehabilitation eye] knowing everything. You may leave knowing a lot of things, but you withal won't accept attained all the goals y'all set for yourself. I have been back home for 3 years, and I yet discover new things, some movements; in my stance, our torso is made to recover in its own time.

(p#xix–FG4)

Participants often described their learning process as extremely slow and emotionally burdensome due to the absence of any nigh-term points of reference. Every single twenty-four hour period, they faced uncertainty, never knowing what deportment might represent progress and relying on trial-and-fault to accomplish given goals. Moreover, the fear of declining in cocky-management or harming themselves led some participants to abjure from specific behaviours, relying entirely on others for the fulfilment of bones personal needs. Several participants expressed guilt for not being independent and having to rely on someone else.

It really destabilises yous, (…) you are afraid that yous are becoming a kid again and starting from scratch, at an historic period that, at least in my example, is already quite advanced, isn't it?!"

(p#14–FG3)

Individual characteristics influencing education

Participants said that didactics was essential to accomplish progress in the rehabilitation process. Participants' experiences converged in the clarification of educational activity as essential both in the acute stage and at dwelling house later on discharge, and private characteristics played an essential role in education. In particular, having potent motivation emerged as a crucial gene in post-obit all provided recommendations. Participants placed great emphasis on the importance of having a personal commitment to overcoming their new condition, and to reinvent themselves in different contexts, in which working, being independent, and existence useful were depicted as primary goals.

I went back to my place of piece of work …to the city surveyor's office, and I stayed on in that location, working at my drafting table until I retired. Nobody at the spinal unit could believe information technology. [They] came to meet where I worked, what I did, how I handled it.

(p#i–FGI1)

Participants also frequently used the reinforcing upshot of gratification to acquire the knowledge and specific skills they needed to manage their condition, which sometimes led to a tendency to put themselves in a higher place all else. At the same time, it was not piece of cake for individuals with SCI to sympathize how much they could achieve using the cocky-learning approach, and when and to whom they could refer to get additional aid when needed.

I've ever taken poor care of myself in general. I've always been, I shouldn't say it myself, only generous I am enough towards others and neglected myself a lot. (…) later the accident, I understood I had to put myself kickoff and everything else had to come up afterwards.

(p#17–FG3)

Environmental and social characteristics influencing education

Ecology and social characteristics besides appeared to accept an outcome on education during rehabilitation. In particular, the time needed to acquire cocky-management skills was perceived to be excessively long in relation to the complexity of the state of affairs, and participants agreed that they needed more than time to be able to attach to healthcare professionals' requests. Participants expressed a general complaint towards healthcare professionals who were inflexible and presented information besides quickly. They felt that professionals' time direction was mainly based on organisational needs and bureaucracy, rather than patients' needs, creating boosted distress and disorientation. Participants suggested that a possible solution for professionals should exist explaining the priority given to sure activities or educational elements during rehabilitation.

They told me to accept driving lessons, simply I didn't intendance most driving anymore, it was the concluding thing on my mind. I protested, because I preferred to first be contained in washing my confront, dressing, non driving.

(p#11–FG2)

Subsequently discharge from hospital, participants reported that they were overwhelmed with doubts most how to use the skills they learned during the rehabilitation process in their real lives, and they wondered if they had actually acquired all the necessary information. They reported a lack of continuity between the rehabilitation centre and the customs care centres and full general practitioners, which were both perceived as less useful. Indeed, participants believed these institutions lacked adequate knowledge on SCI and that the rehabilitation eye was the only place they could to plough to in case of demand.

When I take to come hither [to the rehabilitation center], I feel like I'm going to sky (…) I withal come hither for physiotherapy, I come to use the pool, and it'due south a skilful thing for me, it's a fabulous thing to come here.

(p#21–FG4)

Family and loved ones were often depicted every bit personal resource that participants could count on to overcome the difficulties in their rehabilitation path and every bit the bridge that continued them with the real world, even when the price was intrusiveness. In the absence of a supporting family, participants reported that it was challenging to have complex needs fulfilled, and they described taking specific self-management information from the Internet or other culling channels.

Fortunately, my family unit has kept me decorated since the beginning. Really, I did not have time to call up, and, in the cease, it was a positive matter.

(p#9–FG2)

Participants reported that peers were another important resource in overcoming struggles and avoiding recurring negative thoughts. During the FGs, participants mentioned that sharing practical insights and facing difficulties with peers represented an important opportunity. They expressed their desire to exist involved in more than group activities or sports, fifty-fifty in early rehabilitation, when their schedule was managed past the healthcare professionals. Participants identified therapeutic trips, leisure activities, and home visits with healthcare professionals and peers as the almost effective educational tools they had during early rehabilitation, as those moments were similar to their belch experience.

Exterior is different. Considering reality is exterior, during rehabilitation you accept dwelling house visits …I got to have my first i after 4 months (…). I spent the night in my ain home for the commencement time in October. I recollect that dwelling house visits are actually necessary, because they make y'all exercise the things you need to do …take the car, go outside, then yous can see how you can manage yourself at home.

(p#2–FG1)

Give-and-take

This report immune us to explore specific, perceived barriers and facilitators of educational programmes offered during rehabilitation amongst people with SCI. Participants stressed that learning was an ongoing procedure, made upwards of consecutive phases, that started during rehabilitation and continued in one case they were dorsum dwelling. Moreover, they highlighted some systemic weaknesses of rehabilitation, such equally healthcare professionals' time management, their lack of communication, and their focus on clinical outcomes. Although the demand of SCI survivors for an educational follow-up, participants found a poor connection between rehabilitation and community. The sensation by healthcare professionals of the complex trajectory followed by SCI survivors, the importance of strengthening individual resources, and the involvement of peers and families may constitute resources to improve education in this population.

Consistent with other studies, rehabilitation following SCI was perceived as a stage in which every single activity, combined with medical management, is exhausting and has an effect on individuals' readiness to learn [xv]. Concrete and psychological stressors experienced by SCI survivors during early rehabilitation represent barriers to their participation in educational programmes [13]. The acute phase was mainly characterised past high distress due to the injury, that is not connected to the extent of SCI but can negatively bear upon the coping procedure and the credence of the condition [vii, 24]. Moreover, participants confirmed that the exposition to distress due to overwhelming concrete changes led to difficulties understanding the relevance of educational information [viii]. Our findings confirmed that, following an acquired disability, people experience a deep sense of grief [25], that in SCI has been described as a body/heed separation, in which one'due south own trunk is perceived equally a dead person [26]. Longitudinal studies showed that grief-induced responses occur immediately after a loss and reject within the post-obit half-dozen–12 months, when pre-loss functions are recovered [27, 28]. Within this flow, participants reported they faced difficulties in understanding, remembering, and applying educational information and recommendations. The perceived decline in grief lines up with the moment of acceptance [29], thus assuasive a balance between the maintenance of pre-injury goals and the adaptation to current needs [30, 31]. Therefore, because that attempts to educate people with SCI might oftentimes fail whilst dealing with their distress, healthcare professionals should consider the cess of individuals' readiness to learn as an important resource to improve the effectiveness of education they provide during rehabilitation [7].

After a SCI, a large book of information has to exist acquired in a express corporeality of time [32]. This generates a sense of frustration, as participants are forced to acquire several skills quickly while they are distressed, and is difficult to empathise the link between the data provided and its broader telescopic [13] because they take non yet experienced ADL and related secondary weather condition [33]. Information technology follows that the length of stay in inpatient rehabilitation was perceived to be insufficient when considering the sheer volume of information that had to be acquired [12]. Consistently with other studies, healthcare professionals were ofttimes seen as inflexible, with learning priorities that seemed to be different from those set by participants [34], who reported feeling that they were discharged before their educational needs were met. As a upshot, participants felt they could simply rely on a trial-and-error arroyo, which has already been reported to happen when expert guidance is defective [35]. Part of these behaviours in professionals could be explained by the scheduling issues and resource scarcity affecting educational programmes [32]. Withal, healthcare professionals should select the educational topics and required skills co-ordinate to the diverse stages of rehabilitation, their perspectives, and those of people with SCI [eleven, 13]. Moreover, it is fundamental to structure educational programmes justifying the recommendations provided, and their link with everyday life. Real-life scenarios, problem-based learning, e-learning, or even virtual reality are promising tools that can be practical in educational programmes to foster self-direction skills and encourage self-direction [32]. Our findings further encourage the implementation of specific preparation for healthcare professionals to ameliorate patient-clinician advice, which could assist staff better empathise patients' needs and expectations. This tin help in setting tailored, doable goals, strengthening the partnership betwixt patients and rehabilitation staff, and progressively humanising the learning process afterward SCI [34].

Participants emphasised the difficulties experienced by individuals with SCI in metaphorically "cutting the cord" from the rehabilitation centre, where ecology, cultural, and economic barriers practice not exist [36, 37]. Individual characteristics, such every bit hope and motivation, are crucial to foster the connection between new life perspectives and by interests, and should be promoted throughout the rehabilitation process towards a psychological back up [8]. Interventional approaches, including problem-focused activities and cognitive behavioural therapies, were suggested to be effective in promoting cocky-acceptance and post-traumatic growth, and in favouring positive aligning and maintenance after rehabilitation [38]. At discharge, the presence of ecology and social barriers strengthened the role of the family and peers in overcoming difficulties. Family unit caregivers accept received increasing attending for their key responsibilities in maintaining SCI survivors' motivation and well-being [39]. Moreover, peer support, especially during sports and leisure activities, has been shown to help people with disabilities feel socially recognised, besides as enhancing education effectiveness [twoscore]. Involving families and peers to overcome distress in the acute phase, even in recreational sports or grouping activities, was plant to exist helpful for people with SCI, equally it improved cocky-confidence, self-efficacy, readiness to face ADL [xl], and re-hospitalisation rates [34, 41].

Given the increase in life expectancy, combined with the growing number of individuals with SCI struggling to live independently in their households [33], more resource must be allocated to reduce the distance, also experienced by participants, between rehabilitation centres and the community. Community-based programmes would be suitable to bridge the gap between the rehabilitation eye and SCI survivors' homes, but there are currently few healthcare professionals prepared to deliver such programmes [33]. A possible solution would be to encourage outpatients and customs groups to develop education programmes in the community, supervised by experts from rehabilitation centres and using loftier tech resources to simplify communication [42]. In this connection, during the transition betwixt rehabilitation and social reintegration earlier belch, individuals with SCI need to acquire about the bachelor educational resources in their community [32]. Despite general concerns virtually their quality, online resource are an indispensable resources for people with SCI, as they are accessible and easy to apply, gaining recently more popularity, as they tin encounter private learning needs and styles [42]. Moreover, technology and telehealth is condign popular as it enables individuals with SCI the possibility of limiting their travel and healthcare professionals to monitor their status [43]. In this connection, adapted technology may potentially stand for an educational tool combining the possibility of regular goal setting and follow-up in this population. Future studies are needed to understand the effectiveness of educational programmes in people with SCI in terms of well-existence and the occurrence of secondary weather condition following discharge in order to develop programmes focused on a core set up of basic skills to be provided at the correct stage of rehabilitation. In this regard, the utilize of standardised tools, including measures of depression or motivation, could exist useful in assessing the bear upon of the instruction provided on the mental health of people with SCI.

Limitations

The results of this study should be interpreted within its limitations, including the relatively express sample size and the sampling procedures. Participants were chosen from the leading rehabilitation heart in the due north of Italian republic, which has long-standing expertise in the diagnosis and treatment of SCI. The inclusion of 31 participants divided into iv FGs should have guaranteed sufficient coverage of the gear up of concerns nether investigation [21]. The main reason for refusal to participate was logistical difficulties not straight connected to the report purposes; therefore, sampling bias should have minimal effects on the study results. Fifty-fifty if our participants were from a specific geographical context, our findings were consistent with available studies conducted in different settings. Lastly, although researchers were external to the hospital staff, the location of the FGs could have represented a further bias, as participants may not accept felt they could freely express their thoughts and still protect the professionals they dealt with during rehabilitation. This study followed a qualitative pattern that was valuable in describing the experiences of the participants, although information technology did not let the evaluation of the influence of their clinical or socio-economic characteristics on perceived instruction. Effects of variables such as gender, historic period, injury severity, and financial condition or admission to services on teaching need to be enriched through quantitative studies that might approve our findings. Furthermore, equally we did not have whatever data that could link the education provided with infirmary re-admissions, our ability to make up one's mind the real effect of the educational plan on this outcome was limited.

Conclusion

Education is one of the basic, simply complex aspects of rehabilitation after SCI. Healthcare professionals should be aware of the great efforts SCI survivors must make to master this complexity, given the emotional distress perceived, and be prepare to learn. Therapeutic and educational processes demand to be conducted in parallel and an educational focus on a core set of information to be provided with each stage of rehabilitation is recommended. Wellness providers must stress the relevance of the education provided, peculiarly when individuals with SCI and their caregivers lack experience in a home environment. Moreover, the involvement of families, peers, and community services in learning interventions during rehabilitation is highly recommended to promote the effectiveness of didactics and improve the well-being of SCI survivors. The development of structured educational programmes based on the experiences of healthcare professionals and people living with SCI is essential to increase knowledge and improve the health perspective of SCI survivors, their families, and providers.

Acknowledgments

Authors wish to thank the participants and the staff at the Spinal Unit of Città della Salute east della Scienza Hospital of Turin for dedicating their time to this report. They also wish to thank the delegates of Professional Standards Editing for their support in the linguistic revision of the commodity.

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Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240600

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