Rehabilitation Priorities and Employment Reintegration Among Individuals with Spinal Cord Injury Receiving Home-Based Care: A National Cross-Sectional Survey of Functional and Social Determinants

Hongxia Pan,1,2 Mingfu Ding,1,2 Yue Yang,1,2 Jianmei Zhang,1,2 Liang Zhu,1,2 Quan Wei1,2 1Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People’s Republic of ChinaCorrespondence: Quan Wei, Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China, Email [email protected]: Spinal cord injury (SCI) individuals undergoing home-based rehabilitation face multiple challenges, including functional impairments, bladder dysfunction, and employment barriers. Poor bladder management impacts autonomy, health, and quality of life, while limited mobility and environmental inaccessibility hinder return-to-work.Objective: To assess rehabilitation priorities and unmet needs among home-based individuals with SCI, focusing on bladder management, functional limitations, and employment reintegration. The study aims to identify personal, medical, and environmental factors affecting rehabilitation outcomes.Methods: A cross-sectional survey was conducted from May to September 2023 by West China Hospital, Sichuan University. A total of 3,055 SCI individuals across mainland China completed an online questionnaire assessing demographics, functional status, rehabilitation goals, and employment challenges. Descriptive statistics, t-tests, ANOVA, Chi-square, and multivariate regression were used for data analysis.Results: Challenges: Most participants (80.88%) had traumatic SCI. Significant daily life barriers included financial burden (46.0%), unemployment (44.1%), accessibility issues (34.3%), health concerns (29.5% frequent medical visits; 25.7% persistent issues), and stigma (26.8%). Only 2.7% could walk ≥ 1 km independently. Rehabilitation Goals: Bladder function improvement (49%) was the top priority, followed by restoring mobility (standing 17%; walking 16%) and preventing complications (10%). Notably, 63.3% did not define specific bladder management targets. Predictors: Multivariate analysis showed that thoracic/cervical injury, complete paralysis, and limited mobility were predictors of prioritizing bladder management (p< 0.001). Employment reintegration was significantly influenced by mobility level, environmental accessibility, and social factors such as stigma and recurrent illness.Conclusion: SCI individuals face intertwined challenges that impact rehabilitation and social participation. Bladder care, mobility, psychosocial stressors, and environmental access are key factors shaping rehabilitation priorities and employment outcomes. Individualized, biopsychosocial approaches are essential to promote recovery and community reintegration.Keywords: spinal cord injury, home-based rehabilitation, neurogenic bladder, functional impairment, employment reintegration, environmental barriers, multivariate analysis