Perspectives and challenges for delivering spinal cord injury research and exercise interventions during inpatient rehabilitation in the UK

Abstract Background The subacute period following spinal cord injury (SCI) is an important window for rehabilitation and exercise research, yet delivering clinical trials during inpatient rehabilitation within the UK National Health Service (NHS) is challenging. Fragmented care pathways, limited specialist capacity, workforce and bed pressures, complex governance, and variable clinical practice can restrict recruitment, intervention delivery, and follow-up. Main body Drawing on experiences from three recent UK inpatient exercise-intervention trials, relevant SCI rehabilitation literature, and perspectives from senior rehabilitation clinicians, we examine barriers and opportunities for delivering research during subacute SCI rehabilitation. The Consolidated Framework for Implementation Research (CFIR) and RE-AIM framework are used to consider factors affecting research reach, adoption, implementation, and maintenance. Key challenges include delayed access to specialist rehabilitation, patient readiness and consent burden, competing clinical and therapy priorities, limited protected research time, variable research infrastructure across centres, and difficulties retaining participants following discharge. Greater integration of research and clinical care may be supported by patient-centred and staged recruitment, earlier clinician involvement in study design, protected research time, more coordinated research infrastructure and governance, pragmatic and flexible trial designs, and hybrid delivery incorporating inpatient, remote, or home-based components. Conclusion Subacute SCI rehabilitation provides an important opportunity for evidence to improve long-term care, but current NHS structures can make such research difficult to deliver. Embedding research more closely within routine rehabilitation, while aligning study procedures with patient priorities and clinical realities, may improve feasibility, participation, and translation into practice.