Functional recovery and adaptation after spinal cord injury: a qualitative study of patient experiences and system influences in Singapore

Abstract Spinal cord injury (SCI) disrupts mobility, bodily autonomy, and everyday functioning, requiring ongoing adaptation beyond physical rehabilitation. This study aims to explore how individuals experience and make sense of functional recovery and adaptation after SCI within the Singapore context. We used an interpretative phenomenological analysis (IPA) approach to examine lived experiences following SCI. Ten participants (8 men, 2 women; aged 37–78) receiving outpatient rehabilitation follow-up after spinal cord injury were recruited from rehabilitation clinics. Semi-structured interviews (60–90 min) were conducted, transcribed verbatim, and analysed idiographically before developing cross-case themes. Participants described recovery as something they had to actively work at each day, often measuring progress through small changes such as standing, transferring, or walking short distances. Recovery depended not only on changes in their bodies but also on help from caregivers and the practical constraints of healthcare and transport systems. Five themes were identified: (1) diagnosis as rupture and recovery as sustained work; (2) embodied disruption affecting daily functioning and autonomy; (3) relational labour, with family members and live-in helpers supporting functional independence; (4) system constraints, including financial and transport barriers that limited participation and access to rehabilitation; and (5) adaptation through incremental goal-setting and pacing to maintain function in daily life. Recovery after SCI involves continuous functional adaptation across personal, social, and system domains. Addressing intimate care needs, caregiver capacity, and structural barriers may enhance rehabilitation outcomes and support sustained participation in everyday life.