Community reintegration of persons with traumatic spinal cord injury in Northern India: a cross-sectional study.

Abstract

Since early interventions have improved survival in traumatic spinal cord injury (TSCI), there is a shift toward addressing long-term outcomes like community reintegration and social participation. Despite its importance, community reintegration remains under-researched, particularly in Northern India. This study aims to explore societal reintegration in people with TSCI in Northern India using the Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF). The CHART-SF examines the impact of age, gender, injury level, terrain, and the ASIA impairment scale (AIS) on physical independence, cognitive independence, mobility, occupation, social integration, and economic self-sufficiency. This cross-sectional observational study included 91 individuals with TSCI who had an injury duration greater than 1 year and received inpatient and outpatient services from our department in a tertiary health care centre between October 2022 and April 2024. Community reintegration scores were low in all areas measured by the CHART-SF, such as physical independence (38.5), cognitive independence (64.5), mobility (38.9), social integration (70.9), and economic self-sufficiency, with occupation (13.6) being the most affected domain. The mean CHART-SF score was 226.4 (56.8) out of a maximum of 600, indicating poor reintegration. Being motor complete (AIS A-B) was moderately-to-strongly associated with worse physical independence (rpb = 0.91, P < 0.001), mobility (0.87, P < 0.001), occupation status (0.56, P < 0.001), and overall community reintegration (0.84, P < 0.001). The cognitive independence (64.5) and social integration scores (70.93) were not correlated with any demographic and injury variables assessed and were among the highest-scoring domains. The results suggest significant challenges in societal reintegration among individuals with TSCI in Northern India, particularly in mobility, physical independence, and occupation. While cognitive and social integration were relatively better, overall reintegration remained low. The injury severity, terrain, and other demographic factors influenced outcomes, especially in physical domains.