A Community Reintegration Model for Persons With Traumatic Spinal Cord Injury in South Africa: Process and Outcomes.

Background: Traumatic spinal cord injury impacts physical functioning, independence, and quality of life. The high incidence rate of 75.6 per million in South Africa indicate the crucial role of successful community reintegration. Despite South African's policy emphasizing comprehensive rehabilitation of persons with disabilities, community reintegration following spinal cord injury remains inadequate.

Objective: To develop a multidimensional model to improve community reintegration for individuals with traumatic spinal cord injuries in South Africa.

Methods: A 4-phase mixed methods study was employed. Phase 1 used a cross-sectional survey of 108 individuals with spinal cord injuries to investigate levels and factors influencing psychosocial and community reintegration. Phase 2 involved 28 qualitative interviews with different content experts, including individuals with spinal cord injuries, caregivers, rehabilitation professionals, and persons representing people with disabilities in the communities. Phase 3 reviewed existing community reintegration programs, while Phase 4 used a Delphi technique with 10 experts to design and refine program components and strategies.

Results: The study revealed low levels of psychosocial and community reintegration, influenced by employment and housing factors. Content experts highlighted barriers such as inaccessible environments, transportation challenges, and negative societal attitudes. Program components included technological support, employment assistance, mentorship, and recreational activities. The first 3 phases informed a development of a 3-level model addressing client, community, and legislative domains. In the fourth phase, experts reached consensus on components and strategies to achieve this multi-level community reintegration model.

Conclusion: The evidence-based community reintegration model offers a structured, multi-level framework to address reintegration challenges in South Africa. It emphasizes coordinated interventions at individual, community, and policy levels to improve outcomes for individuals with traumatic spinal cord injuries.