Social Participation And Its Influencing Factors For Patients With Spinal Cord Injury At Home

ObjectiveThe purpose of this study was to evaluate the demographic situation,neurological status,daily activity ability,psychological status,social support and social participation level of patients with spinal cord injury(SCI)after discharge for 3-24 months,and explore social participation level and its influencing factors by collecting relevant data.And to provide theoretical basis for the rehabilitation nursing intervention,eventually promote the patients with spinal cord injury integrate into the family and participate in the society.MethodsFrom September 2016 to September 2017,a total of 262 patients with spinal cord injury from two 3-A hospitals as research subjects.We used general data questionnaire(self-designed questionnaire),American Spinal Injury Association(ASIA),modified barthel index(MBI),hospital anxiety depression scale(HAD),social support rating scale(SSRS)andChinese version of Impact on Participation and Autonomy Questionnaire(IPA)to investigate patients' general information,body structure and function,activities of daily living,mental health,social support and social participation.EpiDate 3.1 and SPSS 24.0 statistical software was used to analyze statistical.General background data,ASIA scores,MBI scores,HAD scores,SSRS scores and the Chinese version of IPA in the patients with spinal cord injury were descriptive analyzed.Single factor method was used to analyze the correlation between general background data,ASIA,MBI,HAD,SSRS score and Chinese version IPA.Multiple factor method was used to analyze the social participation level of patients with spinal cord injury and its influencing factors(P<0.05).Result1.Demographic data: In this study,there were 262 cases of SCI patients,173 were male,89 were female,and the average age(40.56±15.09),the majority were young adults(aged 18~50 years 193,73.6%),there were 164 with spouses(including cohabitation).The level of education was mainly secondary and below(222 cases,85.7%),and47.7% income per of family was 3000-5000,93.1% of the patients lived with their families,90.1% of the patients were taken care of others,27.9% of the patients were on the job,64.1% of patients' family environment was not modified and the community with obstacle facilities(39.3%),and 88.5% of the patients received rehabilitationexercise,81.3% of patients choose home rehabilitation,26.3% of patients have knowledge of the disease.2.The main causes of SCI were traffic accidents(38.9%),high altitude falling(23.3%)and falling(13%),SCI patients were mainly incomplete(64.6%).The average score of ASIA was(233.75±56.53).The most common injuries were cervical and thoracic(98 in the cervical segment,37.4%,107 in the thoracic segment,40.8%),95.4% of patients had one or multiple dysfunction and 25.6% of patients had complications.3.The daily living ability of 262 SCI patients at home was(66.86±23.93),59.5% of patients living with their self-care,23.7% of patients living with help,14.5% of patients living with significantly dependent,2.3% of patients living completely dependent.4.Psychological state: the average depression was(9.12±3.87),the positive rate was 67.9%,The average anxiety was(7.16±3.92),the positive rate of anxiety was 45.0%.5.Social support: the average of objectively support was(8.00±1.57),subjective support was(19.35±3.41),and support availability was(6.37±1.89).6.The social participation level scales of patients with spinal cord injury as the following: the total score of independent participation(45.39±17.62),indoor independent participation(10.09±6.75),family roles independent participation(12.6±4.35),outdoor independentparticipation(15±5.93)and social life independent participation(7.7±3.97).7.Influencing factors: The influencing factors of social participation with SCI patients are the patient's age,living status,occupational status,sequelae,rehabilitation exercise,activities of daily living,anxiety and depression,and the explained variance was 75.4%;the influencing factors of the indoor participation were the patient's age,rehabilitation training,MBI and subjective support and anxiety,and explained variance was66.0%;the influencing factors of family role participation were the patient's age,current occupation,sequelae,complications,the variation of family environment,rehabilitation,ASIA,and depression and explained variance was 63.3%;The influencing factors of outdoor participation were the patient's living status,current occupation,sequelae,rehabilitation training,ASIA,MBI,objective support and depression,and explained variance was 69.1%;The influencing factors of social life participation were the patient's living status,sequelae,rehabilitation training,objective support and anxiety,and explained variance was47.7%.ConclusionSpinal cord injury occurs mostly in young men.And the causes mainly traffic accident,often accompanied by a variety of sequelae and complication.Social participation of the patients with spinal cord injuryat home presented a moderate degree of restriction.Rehabilitation nursing staff and the families of patients should focus on the social participation status of patients with spinal cord injury and take corresponding improvement measures.The influencing factors of society participation of patients included age,sequela,complications,activities of daily living,anxiety and depression,social support and the facilities of community.In view of the influencing factors,medical staffs should take measures include psychological guidance and support;Enterprises should provide employment opportunities and reduce employment discrimination for patients with spinal cord injury;The government should create a new medical environment for patients,increase the input of medical resources and medical insurance,so as to promote the early rehabilitation of patients,and finally integrate into the family and society.