Reclaiming Independence: Daily Activities and Rehabilitation Goals in Spinal Cord Injury

This study is a cross-sectional, single-center, observational study designed to address a recognized gap in rehabilitation literature concerning person-centered care in Spinal Cord Injury (SCI) . While aligning treatment with patient-specific goals is critical for improving motivation and adherence, most research identifying patient functional priorities has been conducted in Western populations . This research specifically aims to investigate these priorities within the Turkish SCI population, for which currently no data is available, thereby providing a foundation for culturally-relevant and patient-specific rehabilitation planning . The study will be conducted at the Biruni University Hospital Physical Medicine and Rehabilitation inpatient and outpatient clinics .

Participants and Data Collection Participants will complete a custom-designed two-part survey. In addition to the survey responses, relevant clinical and demographic data will be collected.

Survey Instrument: Activities of Daily Living Importance (ADLI) Questionnaire The primary data collection tool is the custom-designed, two-part ADLI Questionnaire. The ADL items were selected based on their relevance to the rehabilitation framework for SCI patients, covering self-care, mobility, and essential functional tasks.

Part 1: Functional Importance Assessment: This section assesses the patient's perceived importance of 10 key ADLs. Participants rate the significance of each ADL using an 10-point Visual Analog Scale (VAS) ranging from 0 (Not important at all) to 10 (Extremely important). The ADLs assessed include Eating, Bathing, Clean Intermittent Catheterization (Bladder emptying), Dressing, Oral/Face Care (Grooming), Sitting, Walking, Wheelchair Use, Transferring, and Sexual Activity.

Part 2: Assessment of Independence Goals: The second part of the survey assessed the participants' targeted post-rehabilitation independence levels for the specified 10 ADLs. Participants selected one of four mutually exclusive categories that reflect standard rehabilitation outcomes:

• Complete Independence (can perform without help),
• Modified Independence (requires an assistive device),
• Assisted (requires personal assistance),
• Total Dependence (unable to perform the activity).

Statistical Analysis: The data were analyzed using the SPSS Statistics 22.0 program. The normality of continuous variables was assessed using the Shapiro-Wilk test. For variables showing a normal distribution, independent samples t-tests and one-way ANOVA were used for group comparisons. For data that did not show a normal distribution, the Mann-Whitney U and Kruskal-Wallis tests were applied. The chi-square test was used for the analysis of categorical data; the Fisher exact test was used when the test conditions could not be met. The statistical significance level was set at p<0.05.

Inclusion criteria

• Male and female patients aged 18-60
• Tetraplegic or paraplegic due to spinal cord injury
• At least 1 month has passed since the rehabilitation begining
• Patients who agree to participate in the study and provide written consent

Exclusion criteria

• Having a disability due to any previous neurological (stroke, MS, Parkinson's, etc.) or orthopedic (amputation, knee prosthesis, etc.) reasons
• Insufficient mental functions to answer all questions