The incidence for spinal cord injury is in the range of 11.5 per million to 58 per million subjects Worldwide, whereas, in India this range is from 15-20 million every year. Community participation and rehabilitation of spinal cord injury is a long process that need considerable healthcare resources and put a significant financial burden on the affected subjects and their families. Community and social participation of subjects with spinal cord injury indicate the adequate rehabilitation. Community participation is a multifaceted phenomenon that is interchangeably used with community reintegration, social participation, and participation in the literature.¹

 

Participation is considered as a process of being a part of mainstream in the community and family life, being contributing and active member of society and their own social groups, and participation in normal responsibilities and roles. The process of community re-integration is seen in three main stages that are named as stability, re‑emergence into society, and withdrawal.²

 

Appropriate assistance, access to specialized equipment, and social support are considered to facilitate the community participation in subjects with spinal cord injury. There is further need for community‑based rehabilitation as it improves the results in subjects having disabilities. Many subjects with spinal cord injury in India have different educational, employment, social, medical, and physical deficiencies as majority of them lives in rural areas that have majority of existing services limited to the cities.³

 

Various studies from the previous literature have assessed different determinants of community reintegration in subjects with spinal cord injury. These factors are mobility capacity, socioeconomic status, mobility aids accessibility, exercise, and environmental barriers. However, existing literature data is scarce and limited linked to community participation, disability level, and functional dependence in subjects with spinal cord injury. Understanding of the major factors of community reintegration is vital to enable policymakers and clinical practitioners to take actions in facilitation of reintegration in subjects with spinal cord injury to the community.⁴ Hence, the present study was aimed to assess the factors affecting the community and social participation of subjects with spinal cord injury in India.

 

The present cross-sectional analytical study was aimed to assess the factors affecting the community and social participation of subjects with spinal cord injury in India. The study was done at Department of Orthopaedics, Government Medical College, Jammu, Jammu & Kashmir. Verbal and written informed consent were taken from all the subjects before study participation. The study assessed 55 Indian subjects with spinal cord injury that participated in the community settings. All the subjects were assessed using WHO Disability Assessment Schedule 2.0 (WHODAS), Craig Handicap Assessment and Reporting Technique (CHART), and Spinal Cord Independence Measure Version III self reporting (SCIM III SR) for assessment of the clinical outcomes. The inclusion criteria for the study were subjects aged >18 years, had spinal cord injury >6 months ago, and underwent rehabilitation therapy within the defined study period. The exclusion criteria for the study were subjects with acute infection or acute illness and were hospitalized within the past three months for any reason. After final inclusion, the data from the study subjects were gathered using the preformed structured proforma. The questionnaire comprised of five parts including the demographic data, details of the spinal cord injury, measurement of the functional independence, measure of functional disability, and objective measure of study participation. Community reintegration was assessed using the CHART-SF (Craig Handicap Assessment and Reporting) technique.5 It certain the degree by which participants can fulfil the roles as they would have done without disability. The questionnaire had 32 questions from 6 domains as economic self sufficiency, social integration, occupation, mobility, cognitive independence, and physical independence. Functional independence in study subjects was assessed using SCIM-III which has 19 questions covering the three domains as mobility, respiratory and sphincter management, and self-care.6 Along with these, WHODAS 2.0 was used for assessment of disability severity in subjects with spinal cord injury comprising of 36 questions covering the 6 domains as participation, life activities, getting along, self-care, mobility, and cognition.7 Statistical analysis for gathered data was done using chi-square test, Fisher’s exact test, Mann Whitney U test, and SPSS (Statistical Package for the Social Sciences) software version 24.0 (IBM Corp., Armonk. NY, USA) using ANOVA, chi-square test, and student's t-test. The significance level was considered at a p-value of <0.05.