The activity and participation profile of persons with traumatic spinal cord injury in the Cape Metropole, Western Cape, South Africa : a prospective, descriptive study

[摘要] ENGLISH ABSTRACT: BackgroundTraumatic spinal cord injury (SCI) remains one of the most serious and devastating injuries oftenresulting in permanent disability and with life changing implications for the individual and his/herfamily. Successful reintegration into community life and employment after SCI is consideredimportant goals of rehabilitation as this has been positively associated with quality of life, selfesteem and life satisfaction. The International Classification of Functioning, Disability and Health(ICF) allows researchers to identify the impact of environmental factors on functioning anddisability. Minimal research, particularly in South Africa, has been done on the impact of theenvironment on persons living with various health conditions and specifically spinal cord injury.ObjectivesThe main purpose of this study was to describe and compare the level of participation of personswith traumatic SCI at two time points (discharge and six months after discharge) from the inpatientrehabilitation setting and to identify the environmental barriers experienced.MethodsA prospective, descriptive study was conducted using consecutive sampling. All patients withtraumatic SCI that were discharged from September 1, 2008 from the Western Cape RehabilitationCentre (WCRC) who were eligible for this study were included. Two questionnaires (one based onthe ICF and one purposely-developed) and the International Standards for the Classification of SCI(ISCSCI) were used. Data were analyzed with the statistical software package STATISTICA.ResultsA person sustaining a traumatic SCI in the Cape Metropolitan area of the Western Cape Province ismost likely to be a male, young (20 to 29 years), of the Black or Coloured race and living in theCape Flats suburbs. More than half of the subjects had a grade eight to ten level of education whichtogether with the lack of employers' responsibilities towards part-time workers might explain thelow percentage (11%) of employment at six months after discharge from the WCRC.Complete paraplegia, occurring mainly in the thoracic cord, was the most common neurologicaldisability found in this study. The most common secondary condition was pain followed byspasticity limiting function. The low incidence of pressure sores and urinary tract infections foundin this study contradicts findings of previous studies.The majority of the subjects were discharged to the same house they were living in at the time oftheir injury. However, due to various architectural barriers, some of them were not able to functionindependently in their homes.Inaccessibility of public transport, the lack of recreational and sport facilities, lack of social supportstructures in the community and inadequate financial resources were the main environmentalbarriers experienced by these individuals.ConclusionThe main finding of this study was the low employment rate and the difficulty experienced withreintegration at community level after SCI. The results of this study confirm the significantcontribution of environmental factors in participation, especially those of transport and education inreturn to work. Fourteen years after the publication of the Integrated National Disability Strategy(INDS) White Paper (1997), legislative strategies to ensure that people with disabilities have equalaccess to social and economic opportunities remain lacking.

[发布机构] Stellenbosch University