Factors Affecting Standing and Walking Outcomes for Individuals with Spinal Cord Injury during In-patient Rehabilitation: a Qualitative Study on the Perspectives of Physiotherapists

Abstract

Purpose: Standing and walking outcomes following spinal cord injury (SCI) vary across rehabilitation centres and therapists. Much of this variation has been attributed to individual patient characteristics. However, insight from frontline health care providers, as well as exploration of comprehensive contributing factors, have been under investigated. This study aimed to explore the perspectives of physiotherapists on factors affecting standing and walking recovery and outcomes during in-patient SCI rehabilitation. Methods: An exploratory qualitative study was conducted using semi-structured focus group interviews. Our qualitative approach was grounded in interpretive description and used reflexive thematic analysis. Results: Ten physiotherapy representatives of seven different in-patient SCI rehabilitation sites across Canada participated. Dosage, organizational culture, length of stay, staffing, equipment, relationships, atmosphere, and mindset were the key factors identified. Our findings also highlight that how factors impact a site may differ, but perspectives on which factors influence standing and walking outcomes were similar. Factors beyond the individual and the relationship of these factors on training dosage were emphasized. Conclusion: Future work is needed to better understand the role of institutional culture, to design and implement potential ways to address key contributing factors, and to evaluate if such initiatives lead to improvements in standing and walking outcomes.