Adaptation to Disability by Individuals with Spinal Cord Injury in Bangladesh: A Post-Injury Analysis from 6 months to 10 years

Abstract

Background: Spinal cord injury (SCI) adversely impacts mobility, independence, and emotional stability. In Bangladesh, challenges are heightened by limited rehabilitation services, financial barriers, and inadequate social support. Understanding how individuals adapt post-injury is crucial for developing effective rehabilitation services that promote community inclusion for those with SCI. Objective: The study aimed to explore how individuals with SCI in Bangladesh adapt to sustainable disability living in the community, and to identify the key predictors that influence their adaptation. Methods: A cross sectional study investigated 210 individuals with spinal cord injuries (SCI) who completed rehabilitation at the Centre for the Rehabilitation of the Paralysed (CRP) and had been in their communities for 6 months to 10 years post-injury. Data were collected using Bangla versions of the WHO Disability Assessment Schedule (WHODAS 2.0) and the Adaptation to Disability Scale-Revised (ADS-R). Descriptive statistics summarized sample characteristics, while chi-square tests, one-way ANOVA, and Kruskal-Wallis tests identified associations. Spearman correlation assessed factor relationships, and multiple regression analysis determined predictors of adaptation to disability. Results: Among 210 participants, 71.4% had moderate disability acceptance, 28.1% had low acceptance, and only 0.5% had high acceptance. Low adaptation was linked to factors like complete injuries, tetraplegia, unemployment, pressure ulcers, and delayed rehabilitation. Interestingly, higher education did not ensure better emotional adjustment. Positive factors for better adaptation included earlier rehabilitation, continued income, and family caregiver support. Significant relationships were identified between adaptation and variables such as disability severity, injury type, employment status, income changes, and rehabilitation timing. Conclusion: Many individuals with spinal cord injuries in Bangladesh face challenges adapting to life after their injuries. The study highlights the importance of timely rehabilitation, ongoing support, and psychosocial care to improve outcomes. Early intervention and community-based rehabilitation can enhance long-term well-being and participation. Key words: Spinal cord injury, adaptation, disability acceptance, WHODAS 2.0, ADS-R, Spearman correlation, community reintegration, Bangladesh