Spinal Cord Injury in a Nation at War: Functional Recovery Priorities of Ukrainian Veterans and Civilians Versus North Americans

Individuals with spinal cord injury (SCI) represent a high-need, high-cost group facing unmet health care needs, particularly in war-affected settings. Veterans with combat-related SCI may experience distinct recovery priorities due to injury severity, psychological comorbidities, and limited access to rehabilitation. This study aimed to identify priorities for functional recovery among Ukrainian veterans with SCI and compare them with Ukrainian civilians and North American civilians. A survey-based study was developed using the Qualtrics XM platform and refined through expert review, SCI advocacy input, and pilot testing. The survey, available in English and Ukrainian, asked participants to rank their top three recovery priorities from 14 motor and autonomic functions. Data from 185 participants with SCI were analyzed, including 33 Ukrainian veterans, 31 Ukrainian civilians, and 121 North American civilians. North American civilians (mean ± SD age, 53 ± 15 years) were older than Ukrainian civilians (39 ± 14 years) and veterans (37 ± 16 years) and had a longer time since injury (19 ± 15 vs. 11 ± 10 and 0.6 ± 0.7 years, respectively). Among participants with paraplegia, the most frequently selected priorities for recovery were bladder function, bowel function, and standing/walking across groups. For those with tetraplegia, priorities differed by group, with arm and hand function most frequently prioritized by civilian participants and bladder function most frequently prioritized by Ukrainian veterans. Ukrainian veterans emphasized mobility and pelvic organ function compared with North American civilians, who expressed broader concerns, including chronic pain and psychological well-being. Ukrainian civilians placed less emphasis on psychosocial and secondary health issues. Rehabilitation strategies should prioritize bladder, bowel, and mobility-related functions while addressing overlooked needs such as sexual function and chronic pain management. These findings highlight both shared and context-specific recovery priorities following SCI. Tailored interventions reflecting the context of war-affected populations may improve outcomes and quality of life for individuals with SCI.