The Patient Experience Across the Care Continuum: Inpatient Rehabilitation, Discharge Preparedness, and Community Reintegration after Spinal Cord Injuries/Disorders

The objective was to describe patient experiences, barriers, and facilitators of inpatient rehabilitation, discharge preparedness, and community reintegration after spinal cord injury and disorders (SCI/D) from the perspectives of Veterans with SCI/D. Methods included a descriptive qualitative design using a virtual focus group analyzed via reflexive thematic analysis. Focus group participants (n = 7) were mostly male, white, injured for 1-10 years, with mean age of 52 years. Two domains were identified. The first domain, Barriers and ways rehabilitation could have improved patient experience, included five themes: (1) insufficient preparation for psychological impacts; (2) inadequate preparation for relationship changes; (3) lack of focus on public outings and `real-world' functioning; (4) rehabilitation service delivery gaps, e.g., unsuitable length of stay and not enough therapy; and (5) lack of a caregiving plan before discharge. The second domain, Facilitators and complements to rehabilitation and discharge transition to community living, identified five themes: (1) specialty care by a cohesive multidisciplinary team; (2) suitable length of stay and helpful therapies; (3) preparedness for discharge; (4) care partner readiness efforts; and (5) involvement of peer/advocacy groups. Our findings can be used to optimize patient rehabilitation approaches during the early period after SCI/D to capitalize on factors that facilitate patient experiences during the rehabilitation periods as well as successful community reintegration. Recommendations include having a specialty care focus, care partner readiness, and peer and advocacy group engagement while addressing patient-identified barriers, e.g., lack of attention to emotional recovery, limited preparation for relationship changes, and limited real-world practice.