Priorities of Patients with Spinal Cord Injury in Different Aspects of Rehabilitation in Turkiye

Priorities of Patients with Spinal Cord Injury in Different Aspects of Rehabilitation in Turkiye | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Priorities of Patients with Spinal Cord Injury in Different Aspects of Rehabilitation in Turkiye Mücahit Atasoy, Eser Kalaoglu, Ömer Bucak, Evrim Coşkun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4180742/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 15 Nov, 2024 Read the published version in Spinal Cord → Version 1 posted 10 You are reading this latest preprint version Abstract This study aimed to understand the needs and expectations of individuals with disabilities caused by spinal cord injuries who require long-term rehabilitation from a rehabilitation hospital. The cross-sectional clinical study was conducted, which included individuals over the age of 18 with spinal cord injuries who had previously been hospitalized in a rehabilitation hospital. The 16-question survey, titled "What should a rehabilitation hospital be like according to patients with spinal cord injuries," was applied to individuals hospitalized in the inpatient service of Çam Sakura City Hospital. It was also given to spinal cord injured people reached through social media. The participants' demographic data was recorded, and the survey was completed by 120 participants, comprising 70 males and 50 females. The mean age was 37.47 ± 11.63 years, with 79 participants being married and 41 being single. Twenty-five participants had graduated from at least one university. The time since the spinal cord injury was less than two years for 20 individuals and more than two years for 100 individuals. The results showed that robotic rehabilitation and psychological support were the most requested rehabilitation elements, while interest in sexual rehabilitation was less than other rehabilitation elements. Furthermore, in the correlation analysis, elderly participants indicated that there should be more specialized services and outpatient clinics. This study highlights the importance of considering the needs and wishes of patients when planning and operating a rehabilitation center. The study clarifies that patients' needs for specialized services and robotic rehabilitation were striking. Additionally, the significance and necessity of sexual rehabilitation should be conveyed to patients. Health sciences/Diseases/Neurological disorders/Spinal cord diseases Health sciences/Health care/Health services/Rehabilitation Health sciences/Health care/Health policy Introduction SCI is defined as a severe neurological condition that occurs due to traumatic and non-traumatic causes, causing motor, sensory and autonomic dysfunctions, which dramatically affects the life of the person. Rehabilitation after spinal cord injury is a process that significantly affects the survival of the patient [1], independence in activities of daily living [2], prevention of complications [3] and return to work [4]. It is recommended to start a rehabilitation program in the early period after acute interventions of post-traumatic patients [5]. In published studies, different results such as the time of admission for rehabilitation after injury, complication rates, and length of hospital stay have been found, but there is a lack of global standardization of specialized rehabilitation services for patients with spinal cord injury [6]. It has been stated that the participation of patients in rehabilitation processes can increase the awareness of professionals and patients and can personalize rehabilitation [7]. The caregivers also stated that patient participation would positively affect the rehabilitation process [8]. In a review exploring the perspectives of individuals with SCI, the desire to be “heard” and person-centered rehabilitation were emphasized. Considering all these, we think that our study, which investigates patients' perspectives and priorities on rehabilitation unit parts, will make a significant contribution to the "co-decision-making" principle. Method The findings presented here are part of a larger study to understand SCI individuals' views and expectations of the rehabilitation hospital. In this study, we included the findings regarding rehabilitation unit parts. Inclusion criteria were being over 18 years of age, at least 6 months after the spinal cord injury, and a history of hospitalization in the rehabilitation clinic for at least 2 weeks. Admission to a rehabilitation hospital for other neurological (Parkinson's, Multiple Sclerosis, etc.), orthopedic (amputation, etc.), oncological and rheumatological reasons is an exclusion criterion. Our survey, which includes questions about patients' demographic information, clinical conditions and priorities for specialized rehabilitation units, was created as a result of an intensive exchange of ideas between spinal cord injury patient association managers and our specialist physician group. Since the survey was prepared on a Likert scale, it contains 5 options. Patients with chronic spinal cord injury, whom we reached through social media and spinal cord injury patient associations, and patients with spinal cord injury in our hospital were included in the study. Responses were collected via Google Survey. Whole participants had a history of hospitalization in our hospital. In the descriptive statistics of the data, mean, standard deviation, median minimum, maximum, frequency and ratio values were used. The distribution of variables was measured with the Kolmogorov-Smirnov test. Chi-square test was used in the analysis of qualitative independent data, and fischer test was used when the chi-square test conditions were not met. Spearman's test was used for ordinal qualitative data and Pearson's test was used for normally distributed quantitative data for correlation analysis. SPSS 22.0 program was used in the analysis. Groupings were made to evaluate the relationship between the patients' clinical and sociodemographic characteristics and their wishes. The patients were divided into two groups, married and single, according to their marital status. They were divided into two groups according to their education level highschool and univercity. They were divided into two groups according to the length of stay less than 1 month and more than 1 month. According to the duration of the disease, they were divided into 2 groups, less than 1 year and more. Results 150 patients were reached in the study. Thirty patients were excluded from the evaluation because they stated that they were hospitalized in a rehabilitation hospital for other neurological, orthopedic, oncological and rheumatological reasons. Demographic and current disease status data are shown in the table. Tablo 1: Demographic and disease information of the participants Mean ± SD N % Age 37,47±11,63 Sex Male 70 58.4 Female 50 41.7 Martial Status Single 79 65.9 Maried 41 34.2 Education Less than college graduate 95 79.2 Collage graduate 25 20.9 Duration of Disease Less than 1 years 20 16.7 1 years and above 100 83.4 Urinary Continence Continent 32 26.7 Incontinent 88 73.4 Rectal Sensation Present 60 50 Senseless 60 50 Length of Stay in Hospital Less than 1 month 31 25.9 1 month and more 89 74.2 Among the questions we asked about the rehabilitation process, participants gave the highest “Definitely should be” choice to "Should there be robotic rehabilitation?".The second most popular option that received a "definitely should be" response was related to the provision of psychological support. In the sexual rehabilitation question, the participants marked the "definitely shouldn't be" option with the highest rate, and the "definitely should be" option with the lowest rate among the other specialized units' necessary questions. Also the highest "I had no opinion" answer was to sexual rehabilitation. Table 2: Answers to questions about special rehabilitation units. Definitely should be n % Should be n % No idea n % Shouldn’t be n % Definitely shouldn’t be n % Should there be specialized "spinal cord injury outpatient clinics" for your checkups? 78 65 25 20.84 12 10 2 1.67 3 2.5 Should there be occupational therapy? 77 64.17 30 25 8 6.67 3 2.5 2 1.67 Should there be pressure ulcer training? 80 66.67 24 20 12 10 1 0.84 3 2.5 Should there be hand rehabilitation? 67 55.84 37 30.84 12 10 3 2.5 1 0.84 Should there be robotic rehabilitation? 91 75.84 20 16.67 7 5.84 1 0.84 1 0.84 Should there be virtual reality rehabilitation? 55 45.84 32 26.67 29 24.17 2 1.67 2 1.67 Should there be bladder rehabilitation? 78 65 32 26.67 9 7.5 0 0 1 0.84 Should there be bowel rehabilitation? 71 59.17 34 28.34 13 10.84 1 0.84 1 0.84 Should there be sexual rehabilitation? 43 35.84 31 25.84 37 30.84 0 0 9 7.5 Should there be psychological support specialists (psychologists, psychiatrists, etc.)? 88 73.34 22 18.34 6 5 3 2,5 1 0.84 In the correlation analysis, there was a weak positive correlation between those who were older and those who answered affirmatively to the question of whether the inpatient service should be specialized for patients with only spinal cord injury (p<0.01, r=0.24). Also there was a weak positive correlation between older individuals and those who selected more "should be" options in the question "Should your outpatient service be specialized for only spinal cord injuries?" (p<0.01, r=0.18). A positive but weak correlation was found between high education levels and selecting more "should be" options for Occupational Therapy (p<0.01 r=0.3) and Hand Rehabilitation (p<0.05 r=0.22). Table 3: Correlation table of the positive answers given to the questions in the private rehabilitation units group with patients with long hospital stays. Question P value R value Should there be specialized "spinal paralysis outpatient clinics" for your checkups? <0.01 0.25 Should there be pressure ulcer training? <0.05 0.21 Should there be hand rehabilitation? <0.01 0.23 Should there be robotic rehabilitation? <0.05 0.19 Should there be virtual reality rehabilitation? <0.01 0.30 Should there be bladder rehabilitation? <0.05 0.21 Should there be sexual rehabilitation? <0.05 0.18 Should there be psychological support specialists (psychologists, psychiatrists, etc.)? <0.05 0.18 There was no gender difference in the answers given to the question "Should there be sexual rehabilitation?". There was no significant difference between incontinent and continent participants in their answers that bladder rehabilitation should definitely be (p=0.93). There was no significant difference in bowel rehabilitation preferences between patients with and without sensation in the anus (p=0.57). No significant correlation was detected between the answers given to the questions and other groupings. Discussion In a review of specialized SCI centers, early transfer of the individual with SCI to an integrated multidisciplinary care center is recommended because it reduces the total length of stay, overall mortality, and the number and severity of complications [10]. In a multicenter study, it was found that patients with SCI were functionally better at the end of rehabilitation in specialized centers [11]. It has been shown that the environment and the approach of the rehabilitation team, as well as the accurate understanding of their current medical condition and possible prognosis, have an impact on the decisions made by individuals with SCI when dealing with the complex health problem they face [12]. In this study, we investigated patients' expectations from rehabilitation centers that will play a crucial role in their lives after the acute period. Although patients' medical expectations after rehabilitation and general hospital expectations have been investigated, no patient expectation studies have been conducted for specialized rehabilitation units as in our study. European Spinal Cord Injury Federation recommends that individuals with SCI receive treatment from the acute stage and lifelong follow-up in specialized centers [13]. Additionally, with results similar to our study, individuals with SCI also prefer specialized centers [14]. In the study investigating the applications of individuals with SCI to specialized SCI outpatient clinics, it was found that more than half of 1294 patients (51%) went for annual check-ups. In our study, the majority of the patients (85.84%) responded that there should be a specialized outpatient clinic, while the older ones stated that there should be specialized units in both the inpatient and the outpatient clinic. It has also been reported that the needs of individuals with SCI are not adequately met in primary health care services [15]. Considering all these, we think that specialized SCI outpatient clinic services for routine checks should be increased. In a meta-analysis of robotic rehabilitation conducted in 2020, which included 18 studies, it was stated that it could improve spasticity and walking ability in people with SCI. No significant change in pain was detected after robot-assisted walking training [16]. Although robotic rehabilitation satisfaction is quite satisfactory with a rate of 95% in patients with SCI, as technology advances, the functions of patients with SCI will increase with exoskeleton type robotic devices [17,18]. Most of the robots commercialized today are based on the basic idea that walking is an automatic subcortical ability [19]. However, this needs to be reconsidered in the near future from neuromechanical perspectives, and physiatrists need to determine appropriate treatment methods for the appropriate patient. In this study, 91% of the participants answered the robotic rehabilitation question that it should be. The participants were most interested in robotic rehabilitation. The superiority of robotic rehabilitation over classical rehabilitation is controversial in the literatüre [20]. In our country, studies are needed to determine whether robotic rehabilitation meets physician and patient expectations. Virtual reality was the second type of therapy that participants most frequently selected as the "I have no idea" option. A review investigating the effects of virtual reality devices and movement-based game consoles such as the Wii in stroke rehabilitation reported that virtual reality contributed to functional results compared to traditional treatment, but no difference was detected with game consoles [21]. Considering that patients' knowledge is low, new technology treatments such as virtual reality can be introduced to patients and increase their motivation and gains in rehabilitation hospitals. Our study found that patients with longer rehabilitation periods were more willing to use new technologies such as virtual reality. Neurogenic bladder is as important as physical movement in the quality of life of chronic SCI patients [22]. A specially prepared treatment should be planned to protect the upper urinary tract, support continence and prevent complications [23]. In our study, we expected patients with incontinence to be more interested in bladder rehabilitation, but no significant difference was detected. However the low number of negative answers to the bladder rehabilitation question, compared to other questions, suggests people had achieved awareness. Another important complication, neurogenic bowel disease, is seen in 80% of patients with SCI and has an impact on the quality of life [24,25]. No significant difference was found in the responses to bowel rehabilitation between patients who had sensation in the anal area and those who did not. Participants chose "I have no idea" and "It definitely shouldn't be" most frequently for the sexual rehabilitation question than for any other question. It has been reported that sexual education and information are provided at low rates during the rehabilitation process of individuals with SCI, and while only 18% are satisfied, 36% are dissatisfied [26]. Sexuality can be a sensitive topic for disabled individuals, particularly in cultures where open discussion is discouraged. In countries like ours, sexual life is a life activity that should be hidden and not shared. Expressing the sexual problems of disabled individuals and expecting a solution are not requests that we, healthcare professionals, encounter frequently [27,28]. Further research is needed to determine whether SCI individuals prioritize sexual rehabilitation differently than other aspects of care, and how healthcare professionals can best support their individualized needs. Limitations Given the online survey format, a limitation of this study is the inability to establish clear correlations between specific questions and participants' clinical conditions. Conclusion Patient wishes and priorities are crucial elements in the rehabilitation of individuals with spinal cord injuries (SCI). Our study highlights SCI patients' expectations from rehabilitation hospitals, notably their significant interest in robotic rehabilitation. Furthermore, it underscores the necessity of communicating the importance of sexual rehabilitation. This work may contribute to the literature by emphasizing the patient perspective in tailoring SCI rehabilitation services. Declarations Acknowledgments We would like to thank the participants who attended this study. Informed consent was obtained from all participants in this study. Author contributions All authors conceived and designed the research and conducted the interviews.. MA and EC Wrote the study protocol including conceptualization and design. MA, EK and ÖFB collected the data. MA and EK analyzed the data. MA wrote the first draft of the manuscript, directed by EC. The manuscript was then reviewed by MA, EK, ÖFB and EC. All authors read and approved the final version of the manuscript accepted for publication . Funding No funds, grants, or other support were received. The authors have no relevant financial or non-financial interests to disclose. Ethical Approval The study was approved by the Ethics Committee of Bakirkoy Dr. Sadi Konuk Training and Research Hospital Local Ethics Committee (No: 2020-14-26, dated 07.07.2020). Declaration of conflicting interest The authors declared no conflicts of interest with respect to the authorship and/or publication of this article. References Thietje R, Pouw MH, Schulz AP, Kienast B, Hirschfeld S. Mortality in patients with traumatic spinal cord injury: Descriptive analysis of 62 deceased subjects. The Journal of Spinal Cord Medicine. 2011 Sep;34(5):482–7. Kirshblum S, Brooks M. Rehabilitation of spinal cord injury. In: Gans B, Walsh N, Robinson L, editors. DeLisa’s Physical Medicine and Rehabilitation, Philadelphia: Lippincott, Williams & Wilkins; 2010. p. 665–717 Haisma J, van der Woude L, Stam H, Bergen M, Sluis T, Post M, et al. Complications following spinal cord injury: Occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation. Journal of Rehabilitation Medicine. 2007;39(5):393–8. Yasuda S, Wehman P, Targett P, Cifu DX, West M. Return to work after spinal cord injury: a review of recent research. NeuroRehabilitation [Internet]. 2002 [cited 2024 Mar 27];17(3):177–86. Available from: https://pubmed.ncbi.nlm.nih.gov/12237497/ Sumida M, Fujimoto M, Tokuhiro A, Tominaga T, Magara A, Uchida R. Early rehabilitation effect for traumatic spinal cord injury. Archives of Physical Medicine and Rehabilitation. 2001 Mar;82(3):391–5. Maharaj MM, Hogan JA, Phan K, Mobbs RJ. The role of specialist units to provide focused care and complication avoidance following traumatic spinal cord injury: a systematic review. European Spine Journal. 2016 Apr 1;25(6):1813–20. Pellatt GC. Patients, doctors, and therapists perceptions of professional roles in spinal cord injury rehabilitation: Do they agree? Journal of Interprofessional Care. 2007 Jan;21(2):165–77. Melin J, Persson LO, Taft C, Kreuter M. Patient participation from the perspective of staff members working in spinal cord injury rehabilitation. Spinal Cord. 2018 Jan 24;56(6):614–20. Wang L, Maria Alves Barbosa, Oliveira C, de L, Katarinne Lima Moraes, Vanessa, et al. Health literacy of people with spinal cord injury: a systematic review. Spinal Cord. 2023 Jun 30 Parent S, Barchi S, LeBreton M, Casha S, Fehlings MG. The Impact of Specialized Centers of Care for Spinal Cord Injury on Length of Stay, Complications, and Mortality: A Systematic Review of the Literature. Journal of Neurotrauma [Internet]. 2011 Jul 25;28(8):1363–70. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143414/ Heinemann AW. Functional Outcome Following Spinal Cord Injury. Archives of Neurology. 1989 Oct 1;46(10):1098. Scheel-Sailer A, Post MW, Michel F, Weidmann‐Hügle T, Baumann Hölzle R. Patients’ views on their decision making during inpatient rehabilitation after newly acquired spinal cord injury—A qualitative interview‐based study. Health Expectations : An International Journal of Public Participation in Health Care and Health Policy [Internet]. 2017 Oct 1;20(5):1133–42. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5600242/ European Spinal Cord Injury Federation. ESCIF Policy statement on the treatment, rehabilitation and life-long care of persons with spinal cord injuries (SCI). 2008. [Accessed 27 March 2022]. Available from: http://www.escif.org/ESCIFpolicy_statement.htm Braaf SC, Lennox A, Nunn A, Gabbe BJ. Experiences of hospital readmission and receiving formal carer services following spinal cord injury: a qualitative study to identify needs. Disability and Rehabilitation. 2017 Apr 14;40(16):1893–9. McColl MA, Aiken A, McColl A, Sakakibara B, Smith K. Primary care of people with spinal cord injury: scoping review. Canadian Family Physician Medecin De Famille Canadien [Internet]. 2012 Nov 1 [cited 2024 Mar 27];58(11):1207–16, e626-635. Available from: https://pubmed.ncbi.nlm.nih.gov/23152456/ Kinnett-Hopkins D, Mummidisetty CK, Ehrlich-Jones L, Crown D, Bond RA, Applebaum MH, et al. Users with spinal cord injury experience of robotic Locomotor exoskeletons: a qualitative study of the benefits, limitations, and recommendations. Journal of NeuroEngineering and Rehabilitation. 2020 Sep 11;17(1). Gagnon DH, Vermette M, Duclos C, Aubertin-Leheudre M, Ahmed S, Kairy D. Satisfaction and perceptions of long-term manual wheelchair users with a spinal cord injury upon completion of a locomotor training program with an overground robotic exoskeleton. Disability and Rehabilitation: Assistive Technology. 2017 Dec 19;14(2):138–45. Fazekas G, Tavaszi I. The future role of robots in neuro-rehabilitation. Expert Review of Neurotherapeutics. 2019 May 15;19(6):471–3. Morone G, Paolucci S, Cherubini A, De Angelis D, Venturiero V, Coiro P, et al. Robot-assisted gait training for stroke patients: current state of the art and perspectives of robotics. Neuropsychiatric Disease and Treatment [Internet]. 2017 May;Volume 13:1303–11. Available from: https://www.dovepress.com/robot-assisted-gait-training-for-stroke-patients-current-state-of-the--peer-reviewed-fulltext-article-NDT. Fabbri I, Betti F, Tedeschi R. Gait quality after robot therapy compared with physiotherapy in the patient with incomplete spinal cord injured: A systematic review. eNeurologicalSci [Internet]. 2023 Jun 1 [cited 2023 Aug 24];31:100467. Available from: https://www.sciencedirect.com/science/article/pii/S2405650223000254?via%3Dihub Lohse KR, Hilderman CGE, Cheung KL, Tatla S, Van der Loos HFM. Virtual Reality Therapy for Adults Post-Stroke: A Systematic Review and Meta-Analysis Exploring Virtual Environments and Commercial Games in Therapy. Quinn TJ, editor. PLoS ONE [Internet]. 2014 Mar 28;9(3):e93318. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969329/ Ku JH. The management of neurogenic bladder and quality of life in spinal cord injury. BJU International. 2006 Oct;98(4):739–45. Al Taweel W, Seyam R. Neurogenic bladder in spinal cord injury patients. Research and Reports in Urology. 2015 Jun;7:85. Ozisler Z, Koklu K, Ozel S, Unsal-Delialioglu S. Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction. Neural Regeneration Research. 2015;10(7):1153. Ture SD, Ozkaya G, Sivrioglu K. Relationship between neurogenic bowel dysfunction severity and functional status, depression, and quality of life in individuals with spinal cord injury. The Journal of Spinal Cord Medicine. 2022 Feb 2;1–9. New PW, Seddon M, Redpath C, Currie KE, Warren N. Recommendations for spinal rehabilitation professionals regarding sexual education needs and preferences of people with spinal cord dysfunction: a mixed-methods study. Spinal Cord. 2016 May 10;54(12):1203–9 Akman RY, Çelik EC, Karataş M. Sexuality and sexual dysfunction in spinal cord-injured men in Turkey. Turkish Journal of Medical Sciences [Internet]. 2015 Jan 1 [cited 2023 May 11];45(4):758–61. Available from: https://journals.tubitak.gov.tr/medical/vol45/iss4/3/ Celik EC, Akman Y, Kose P, Arioglu P, Karatas M, Erhan B. Sexual problems of women with spinal cord injury in Turkey. Spinal Cord. 2014 Jan 14;52(4):313–5 Additional Declarations There is no duality of interest Cite Share Download PDF Status: Published Journal Publication published 15 Nov, 2024 Read the published version in Spinal Cord → Version 1 posted Editorial decision: revise 13 Jun, 2024 Review # 1 received at journal 14 May, 2024 Review # 2 received at journal 10 May, 2024 Reviewer # 2 agreed at journal 04 May, 2024 Reviewer # 1 agreed at journal 22 Apr, 2024 Reviewers invited by journal 14 Apr, 2024 Submission checks completed at journal 02 Apr, 2024 First submitted to journal 28 Mar, 2024 Unknown event 28 Mar, 2024 Editor assigned by journal 28 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4180742","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":291110784,"identity":"0e80a70e-39f7-4212-86ac-3c2a08a6a6d1","order_by":0,"name":"Mücahit Atasoy","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABD0lEQVRIiWNgGAWjYDCCAxAqgQ0mwA/mFhCjhY2BsQHEkgSRCQZEaGGAaTEAi+DRwnf7AOtmnhq7PD755ucPfvyxSdx8fnXihwcGDPL8YgewapE8l8B2m+dYcjEbG5thY29bWuK2G283SwAdZjhzdgJWLQZnGNhu8zYwJ7axMRg28DYcBmo5uwGkJcHgNl4t9UAt7B8b//w5nLh5xtnNP4jQchiohcewmYftcOIG/t5teG2RPMPYdnPOseNALTmFs2Xb0oxn3ODdZpFgIIHTL3xnmI/deFNTnTi/+fiGj2/+2Mj295/dfPNHhY08vzR2LQzQ2IADxwYJsEoJHMqxAHsG/gPEqx4Fo2AUjIIRAQCJYGZAt3S8VAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-7553-2410","institution":"Medipol Bahçelievler Hospital","correspondingAuthor":true,"prefix":"","firstName":"Mücahit","middleName":"","lastName":"Atasoy","suffix":""},{"id":291110785,"identity":"0113c486-938e-46d1-9cd3-501f210b3a9d","order_by":1,"name":"Eser Kalaoglu","email":"","orcid":"https://orcid.org/0000-0001-8959-6522","institution":"Istanbul Physical Therapy Rehabilitation Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Eser","middleName":"","lastName":"Kalaoglu","suffix":""},{"id":291110786,"identity":"1c8ac9f5-b43e-4489-8df1-19276357f8fb","order_by":2,"name":"Ömer Bucak","email":"","orcid":"","institution":"Istanbul Physical Medicine and Rehabilitation Training Hospital, Istanbul, Turkey","correspondingAuthor":false,"prefix":"","firstName":"Ömer","middleName":"","lastName":"Bucak","suffix":""},{"id":291110787,"identity":"7f98b0f0-4874-42ac-8981-9d97fdea499b","order_by":3,"name":"Evrim Coşkun","email":"","orcid":"","institution":"Istanbul Physical Medicine and Rehabilitation Training Hospital, Istanbul, Turkey","correspondingAuthor":false,"prefix":"","firstName":"Evrim","middleName":"","lastName":"Coşkun","suffix":""}],"badges":[],"createdAt":"2024-03-28 08:35:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4180742/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4180742/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41393-024-01049-7","type":"published","date":"2024-11-15T05:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":69134465,"identity":"13c64f19-cbd6-41ad-9868-edb1ff0dccea","added_by":"auto","created_at":"2024-11-16 08:08:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":348754,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4180742/v1/096ac786-3f1c-467d-a007-1778a2bdce3e.pdf"}],"financialInterests":"There is no duality of interest","formattedTitle":"Priorities of Patients with Spinal Cord Injury in Different Aspects of Rehabilitation in Turkiye","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSCI is defined as a severe neurological condition that occurs due to traumatic and non-traumatic causes, causing motor, sensory and autonomic dysfunctions, which dramatically affects the life of the person. Rehabilitation after spinal cord injury is a process that significantly affects the survival of the patient [1], independence in activities of daily living [2], prevention of complications [3] and return to work [4]. It is recommended to start a rehabilitation program in the early period after acute interventions of post-traumatic patients [5]. In published studies, different results such as the time of admission for rehabilitation after injury, complication rates, and length of hospital stay have been found, but there is a lack of global standardization of specialized rehabilitation services for patients with spinal cord injury [6]. It has been stated that the participation of patients in rehabilitation processes can increase the awareness of professionals and patients and can personalize rehabilitation [7]. The caregivers also stated that patient participation would positively affect the rehabilitation process [8].\u003c/p\u003e \u003cp\u003eIn a review exploring the perspectives of individuals with SCI, the desire to be \u0026ldquo;heard\u0026rdquo; and person-centered rehabilitation were emphasized. Considering all these, we think that our study, which investigates patients' perspectives and priorities on rehabilitation unit parts, will make a significant contribution to the \"co-decision-making\" principle.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eThe findings presented here are part of a larger study to understand SCI individuals' views and expectations of the rehabilitation hospital. In this study, we included the findings regarding rehabilitation unit parts.\u003c/p\u003e \u003cp\u003eInclusion criteria were being over 18 years of age, at least 6 months after the spinal cord injury, and a history of hospitalization in the rehabilitation clinic for at least 2 weeks. Admission to a rehabilitation hospital for other neurological (Parkinson's, Multiple Sclerosis, etc.), orthopedic (amputation, etc.), oncological and rheumatological reasons is an exclusion criterion. Our survey, which includes questions about patients' demographic information, clinical conditions and priorities for specialized rehabilitation units, was created as a result of an intensive exchange of ideas between spinal cord injury patient association managers and our specialist physician group. Since the survey was prepared on a Likert scale, it contains 5 options. Patients with chronic spinal cord injury, whom we reached through social media and spinal cord injury patient associations, and patients with spinal cord injury in our hospital were included in the study. Responses were collected via Google Survey. Whole participants had a history of hospitalization in our hospital.\u003c/p\u003e \u003cp\u003eIn the descriptive statistics of the data, mean, standard deviation, median minimum, maximum, frequency and ratio values were used. The distribution of variables was measured with the Kolmogorov-Smirnov test. Chi-square test was used in the analysis of qualitative independent data, and fischer test was used when the chi-square test conditions were not met. Spearman's test was used for ordinal qualitative data and Pearson's test was used for normally distributed quantitative data for correlation analysis. SPSS 22.0 program was used in the analysis.\u003c/p\u003e \u003cp\u003eGroupings were made to evaluate the relationship between the patients' clinical and sociodemographic characteristics and their wishes. The patients were divided into two groups, married and single, according to their marital status. They were divided into two groups according to their education level highschool and univercity. They were divided into two groups according to the length of stay less than 1 month and more than 1 month. According to the duration of the disease, they were divided into 2 groups, less than 1 year and more.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e150 patients were reached in the study. Thirty patients were excluded from the evaluation because they stated that they were hospitalized in a rehabilitation hospital for other neurological, orthopedic, oncological and rheumatological reasons. Demographic and current disease status data are shown in the table.\u003c/p\u003e\n\u003cp\u003eTablo 1: Demographic and disease information of the participants\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"508\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.79527559055118%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.874015748031496%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.73228346456693%\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.598425196850394%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.79527559055118%\" valign=\"bottom\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.874015748031496%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;37,47\u0026plusmn;11,63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.73228346456693%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.598425196850394%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.79527559055118%\" valign=\"bottom\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.874015748031496%\" valign=\"bottom\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.73228346456693%\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.598425196850394%\"\u003e\n \u003cp\u003e58.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.79527559055118%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.874015748031496%\" valign=\"bottom\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.73228346456693%\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.598425196850394%\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.79527559055118%\" valign=\"bottom\"\u003e\n \u003cp\u003eMartial Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.874015748031496%\" valign=\"bottom\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.73228346456693%\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.598425196850394%\"\u003e\n \u003cp\u003e65.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.79527559055118%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.874015748031496%\" valign=\"bottom\"\u003e\n \u003cp\u003eMaried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.73228346456693%\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.598425196850394%\"\u003e\n \u003cp\u003e34.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.79527559055118%\" valign=\"bottom\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.874015748031496%\" valign=\"bottom\"\u003e\n \u003cp\u003eLess than college graduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.73228346456693%\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.598425196850394%\"\u003e\n \u003cp\u003e79.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.79527559055118%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.874015748031496%\" valign=\"bottom\"\u003e\n \u003cp\u003eCollage graduate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.73228346456693%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.598425196850394%\"\u003e\n \u003cp\u003e20.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.79527559055118%\" valign=\"bottom\"\u003e\n \u003cp\u003eDuration of Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.874015748031496%\" valign=\"bottom\"\u003e\n \u003cp\u003eLess than 1 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.73228346456693%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.598425196850394%\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.79527559055118%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.874015748031496%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 years and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.73228346456693%\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.598425196850394%\"\u003e\n \u003cp\u003e83.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.79527559055118%\" valign=\"bottom\"\u003e\n \u003cp\u003eUrinary Continence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.874015748031496%\" valign=\"bottom\"\u003e\n \u003cp\u003eContinent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.73228346456693%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.598425196850394%\"\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.79527559055118%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.874015748031496%\" valign=\"bottom\"\u003e\n \u003cp\u003eIncontinent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.73228346456693%\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.598425196850394%\"\u003e\n \u003cp\u003e73.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.79527559055118%\" valign=\"bottom\"\u003e\n \u003cp\u003eRectal Sensation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.874015748031496%\" valign=\"bottom\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.73228346456693%\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.598425196850394%\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.79527559055118%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.874015748031496%\" valign=\"bottom\"\u003e\n \u003cp\u003eSenseless\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.73228346456693%\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.598425196850394%\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.79527559055118%\" valign=\"bottom\"\u003e\n \u003cp\u003eLength of Stay in Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.874015748031496%\" valign=\"bottom\"\u003e\n \u003cp\u003eLess than 1 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.73228346456693%\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.598425196850394%\"\u003e\n \u003cp\u003e25.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.79527559055118%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.874015748031496%\" valign=\"bottom\"\u003e\n \u003cp\u003e1 month and more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.73228346456693%\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.598425196850394%\"\u003e\n \u003cp\u003e74.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAmong the questions we asked about the rehabilitation process, participants gave the highest \u0026ldquo;Definitely should be\u0026rdquo; choice to \u0026quot;Should there be robotic rehabilitation?\u0026quot;.The second most popular option that received a \u0026quot;definitely should be\u0026quot; response was related to the provision of psychological support.\u0026nbsp;In the sexual rehabilitation question, the participants marked the \u0026quot;definitely shouldn\u0026apos;t be\u0026quot; option with the highest rate, and the \u0026quot;definitely should be\u0026quot; option with the lowest rate among the other specialized units\u0026apos; necessary questions. Also the highest \u0026quot;I had no opinion\u0026quot; answer was to sexual rehabilitation.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 2: Answers to questions about special rehabilitation units.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"573\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.377622377622377%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.356643356643357%\" colspan=\"2\"\u003e\n \u003cp\u003eDefinitely should be\u003c/p\u003e\n \u003cp\u003en \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.034965034965035%\" colspan=\"2\"\u003e\n \u003cp\u003eShould be\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; n \u0026nbsp; \u0026nbsp; \u0026nbsp; %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.685314685314685%\" colspan=\"2\"\u003e\n \u003cp\u003eNo idea\u003c/p\u003e\n \u003cp\u003en \u0026nbsp; \u0026nbsp; \u0026nbsp; %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.986013986013987%\" colspan=\"2\"\u003e\n \u003cp\u003eShouldn\u0026rsquo;t be\u003c/p\u003e\n \u003cp\u003en \u0026nbsp; \u0026nbsp; %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.55944055944056%\" colspan=\"2\"\u003e\n \u003cp\u003eDefinitely shouldn\u0026rsquo;t be\u003c/p\u003e\n \u003cp\u003en \u0026nbsp; \u0026nbsp; \u0026nbsp; %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.377622377622377%\" valign=\"bottom\"\u003e\n \u003cp\u003eShould there be specialized \u0026quot;spinal cord injury outpatient clinics\u0026quot; for your checkups?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e20.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.944055944055944%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.468531468531468%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.377622377622377%\" valign=\"bottom\"\u003e\n \u003cp\u003eShould there be occupational therapy?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e64.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.944055944055944%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e6.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.468531468531468%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.377622377622377%\" valign=\"top\"\u003e\n \u003cp\u003eShould there be pressure ulcer training?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e66.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.944055944055944%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.468531468531468%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.377622377622377%\" valign=\"top\"\u003e\n \u003cp\u003eShould there be hand rehabilitation?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e55.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e30.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.944055944055944%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.468531468531468%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.377622377622377%\" valign=\"top\"\u003e\n \u003cp\u003eShould there be robotic rehabilitation?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e75.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e16.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.944055944055944%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e5.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.468531468531468%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.377622377622377%\" valign=\"top\"\u003e\n \u003cp\u003eShould there be virtual reality rehabilitation?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e45.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e26.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.944055944055944%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e24.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.468531468531468%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.377622377622377%\" valign=\"top\"\u003e\n \u003cp\u003eShould there be bladder rehabilitation?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e26.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.944055944055944%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.468531468531468%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.377622377622377%\" valign=\"top\"\u003e\n \u003cp\u003eShould there be bowel rehabilitation?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e59.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e28.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.944055944055944%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e10.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.468531468531468%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.377622377622377%\" valign=\"top\"\u003e\n \u003cp\u003eShould there be sexual rehabilitation?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e35.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e25.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.944055944055944%\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e30.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.468531468531468%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.377622377622377%\" valign=\"top\"\u003e\n \u003cp\u003eShould there be psychological support specialists (psychologists, psychiatrists, etc.)?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e73.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e18.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.944055944055944%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.741258741258742%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.293706293706293%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.6923076923076925%\"\u003e\n \u003cp\u003e2,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.468531468531468%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn the correlation analysis, there was a weak positive correlation between those who were older and those who answered affirmatively to the question of whether the inpatient service should be specialized for patients with only spinal cord injury (p\u0026lt;0.01, r=0.24). Also there was a weak positive correlation between older individuals and those who selected more \u0026quot;should be\u0026quot; options in the question \u0026quot;Should your outpatient service be specialized for only spinal cord injuries?\u0026quot; (p\u0026lt;0.01, r=0.18). A positive but weak correlation was found between high education levels and selecting more \u0026quot;should be\u0026quot; options for Occupational Therapy\u0026nbsp;(p\u0026lt;0.01 r=0.3)\u0026nbsp;and Hand Rehabilitation\u0026nbsp;(p\u0026lt;0.05 r=0.22).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 3: Correlation table of the positive answers given to the questions in the private rehabilitation units group with patients with long hospital stays.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"508\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"76.7258382642998%\" valign=\"bottom\"\u003e\n \u003cp\u003eQuestion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.439842209072978%\" valign=\"top\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.834319526627219%\" valign=\"top\"\u003e\n \u003cp\u003eR value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"79.37062937062937%\" valign=\"bottom\"\u003e\n \u003cp\u003eShould there be specialized \u0026quot;spinal paralysis outpatient clinics\u0026quot; for your checkups?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.13986013986014%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.48951048951049%\" valign=\"top\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"78.6618444846293%\" valign=\"bottom\"\u003e\n \u003cp\u003eShould there be pressure ulcer training?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.488245931283906%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.849909584086799%\" valign=\"top\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"78.6618444846293%\" valign=\"bottom\"\u003e\n \u003cp\u003eShould there be hand rehabilitation?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.488245931283906%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.849909584086799%\" valign=\"top\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"78.6618444846293%\" valign=\"bottom\"\u003e\n \u003cp\u003eShould there be robotic rehabilitation?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.488245931283906%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.849909584086799%\" valign=\"top\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"78.6618444846293%\" valign=\"bottom\"\u003e\n \u003cp\u003eShould there be virtual reality rehabilitation?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.488245931283906%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.849909584086799%\" valign=\"top\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"78.6618444846293%\" valign=\"bottom\"\u003e\n \u003cp\u003eShould there be bladder rehabilitation?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.488245931283906%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.849909584086799%\" valign=\"top\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"78.6618444846293%\" valign=\"bottom\"\u003e\n \u003cp\u003eShould there be sexual rehabilitation?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.488245931283906%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.849909584086799%\" valign=\"top\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"78.6618444846293%\" valign=\"bottom\"\u003e\n \u003cp\u003eShould there be psychological support specialists (psychologists, psychiatrists, etc.)?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.488245931283906%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.849909584086799%\" valign=\"top\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThere was no gender difference in the answers given to the question \u0026quot;Should there be sexual rehabilitation?\u0026quot;. There was no significant difference between incontinent and continent participants in their answers that bladder rehabilitation should definitely be (p=0.93). There was no significant difference in bowel rehabilitation preferences between patients with and without sensation in the anus (p=0.57). No significant correlation was detected between the answers given to the questions and other groupings.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn a review of specialized SCI centers, early transfer of the individual with SCI to an integrated multidisciplinary care center is recommended because it reduces the total length of stay, overall mortality, and the number and severity of complications [10]. In a multicenter study, it was found that patients with SCI were functionally better at the end of rehabilitation in specialized centers [11]. It has been shown that the environment and the approach of the rehabilitation team, as well as the accurate understanding of their current medical condition and possible prognosis, have an impact on the decisions made by individuals with SCI when dealing with the complex health problem they face [12]. In this study, we investigated patients' expectations from rehabilitation centers that will play a crucial role in their lives after the acute period. Although patients' medical expectations after rehabilitation and general hospital expectations have been investigated, no patient expectation studies have been conducted for specialized rehabilitation units as in our study.\u003c/p\u003e \u003cp\u003eEuropean Spinal Cord Injury Federation recommends that individuals with SCI receive treatment from the acute stage and lifelong follow-up in specialized centers [13]. Additionally, with results similar to our study, individuals with SCI also prefer specialized centers [14]. In the study investigating the applications of individuals with SCI to specialized SCI outpatient clinics, it was found that more than half of 1294 patients (51%) went for annual check-ups. In our study, the majority of the patients (85.84%) responded that there should be a specialized outpatient clinic, while the older ones stated that there should be specialized units in both the inpatient and the outpatient clinic. It has also been reported that the needs of individuals with SCI are not adequately met in primary health care services [15]. Considering all these, we think that specialized SCI outpatient clinic services for routine checks should be increased.\u003c/p\u003e \u003cp\u003eIn a meta-analysis of robotic rehabilitation conducted in 2020, which included 18 studies, it was stated that it could improve spasticity and walking ability in people with SCI. No significant change in pain was detected after robot-assisted walking training [16]. Although robotic rehabilitation satisfaction is quite satisfactory with a rate of 95% in patients with SCI, as technology advances, the functions of patients with SCI will increase with exoskeleton type robotic devices [17,18]. Most of the robots commercialized today are based on the basic idea that walking is an automatic subcortical ability [19]. However, this needs to be reconsidered in the near future from neuromechanical perspectives, and physiatrists need to determine appropriate treatment methods for the appropriate patient. In this study, 91% of the participants answered the robotic rehabilitation question that it should be. The participants were most interested in robotic rehabilitation. The superiority of robotic rehabilitation over classical rehabilitation is controversial in the literat\u0026uuml;re [20]. In our country, studies are needed to determine whether robotic rehabilitation meets physician and patient expectations.\u003c/p\u003e \u003cp\u003eVirtual reality was the second type of therapy that participants most frequently selected as the \"I have no idea\" option. A review investigating the effects of virtual reality devices and movement-based game consoles such as the Wii in stroke rehabilitation reported that virtual reality contributed to functional results compared to traditional treatment, but no difference was detected with game consoles [21]. Considering that patients' knowledge is low, new technology treatments such as virtual reality can be introduced to patients and increase their motivation and gains in rehabilitation hospitals. Our study found that patients with longer rehabilitation periods were more willing to use new technologies such as virtual reality.\u003c/p\u003e \u003cp\u003eNeurogenic bladder is as important as physical movement in the quality of life of chronic SCI patients [22]. A specially prepared treatment should be planned to protect the upper urinary tract, support continence and prevent complications [23]. In our study, we expected patients with incontinence to be more interested in bladder rehabilitation, but no significant difference was detected. However the low number of negative answers to the bladder rehabilitation question, compared to other questions, suggests people had achieved awareness. Another important complication, neurogenic bowel disease, is seen in 80% of patients with SCI and has an impact on the quality of life [24,25]. No significant difference was found in the responses to bowel rehabilitation between patients who had sensation in the anal area and those who did not.\u003c/p\u003e \u003cp\u003eParticipants chose \"I have no idea\" and \"It definitely shouldn't be\" most frequently for the sexual rehabilitation question than for any other question. It has been reported that sexual education and information are provided at low rates during the rehabilitation process of individuals with SCI, and while only 18% are satisfied, 36% are dissatisfied [26]. Sexuality can be a sensitive topic for disabled individuals, particularly in cultures where open discussion is discouraged. In countries like ours, sexual life is a life activity that should be hidden and not shared. Expressing the sexual problems of disabled individuals and expecting a solution are not requests that we, healthcare professionals, encounter frequently [27,28]. Further research is needed to determine whether SCI individuals prioritize sexual rehabilitation differently than other aspects of care, and how healthcare professionals can best support their individualized needs.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLimitations\u003c/strong\u003e \u003cp\u003eGiven the online survey format, a limitation of this study is the inability to establish clear correlations between specific questions and participants' clinical conditions.\u003c/p\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePatient wishes and priorities are crucial elements in the rehabilitation of individuals with spinal cord injuries (SCI). Our study highlights SCI patients' expectations from rehabilitation hospitals, notably their significant interest in robotic rehabilitation. Furthermore, it underscores the necessity of communicating the importance of sexual rehabilitation. This work may contribute to the literature by emphasizing the patient perspective in tailoring SCI rehabilitation services.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the participants who attended this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors conceived and designed the research and conducted the interviews.. MA and EC Wrote the study protocol including conceptualization and design. MA, EK and \u0026Ouml;FB collected the data. MA \u0026nbsp;and EK analyzed the data. MA wrote the first draft of the manuscript, directed by EC. The manuscript was then reviewed by MA, EK, \u0026Ouml;FB and EC. All authors read and approved the final version of the manuscript accepted for publication\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funds, grants, or other support were received. The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of Bakirkoy Dr. Sadi Konuk Training and Research Hospital Local Ethics Committee (No: 2020-14-26, dated 07.07.2020).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of conflicting interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no conflicts of interest with respect to the authorship and/or publication of this article.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eThietje R, Pouw MH, Schulz AP, Kienast B, Hirschfeld S. Mortality in patients with traumatic spinal cord injury: Descriptive analysis of 62 deceased subjects. The Journal of Spinal Cord Medicine. 2011 Sep;34(5):482\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKirshblum S, Brooks M. Rehabilitation of spinal cord injury. In: Gans B, Walsh N, Robinson L, editors. DeLisa\u0026rsquo;s Physical Medicine and Rehabilitation, Philadelphia: Lippincott, Williams \u0026amp; Wilkins; 2010. p. 665\u0026ndash;717\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHaisma J, van der Woude L, Stam H, Bergen M, Sluis T, Post M, et al. Complications following spinal cord injury: Occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation. Journal of Rehabilitation Medicine. 2007;39(5):393\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eYasuda S, Wehman P, Targett P, Cifu DX, West M. Return to work after spinal cord injury: a review of recent research. NeuroRehabilitation [Internet]. 2002 [cited 2024 Mar 27];17(3):177\u0026ndash;86. Available from: https://pubmed.ncbi.nlm.nih.gov/12237497/\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSumida M, Fujimoto M, Tokuhiro A, Tominaga T, Magara A, Uchida R. Early rehabilitation effect for traumatic spinal cord injury. Archives of Physical Medicine and Rehabilitation. 2001 Mar;82(3):391\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMaharaj MM, Hogan JA, Phan K, Mobbs RJ. The role of specialist units to provide focused care and complication avoidance following traumatic spinal cord injury: a systematic review. European Spine Journal. 2016 Apr 1;25(6):1813\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePellatt GC. Patients, doctors, and therapists perceptions of professional roles in spinal cord injury rehabilitation: Do they agree? Journal of Interprofessional Care. 2007 Jan;21(2):165\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMelin J, Persson LO, Taft C, Kreuter M. Patient participation from the perspective of staff members working in spinal cord injury rehabilitation. Spinal Cord. 2018 Jan 24;56(6):614\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWang L, Maria Alves Barbosa, Oliveira C, de L, Katarinne Lima Moraes, Vanessa, et al. Health literacy of people with spinal cord injury: a systematic review. Spinal Cord. 2023 Jun 30\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eParent S, Barchi S, LeBreton M, Casha S, Fehlings MG. The Impact of Specialized Centers of Care for Spinal Cord Injury on Length of Stay, Complications, and Mortality: A Systematic Review of the Literature. Journal of Neurotrauma [Internet]. 2011 Jul 25;28(8):1363\u0026ndash;70. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143414/\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHeinemann AW. Functional Outcome Following Spinal Cord Injury. Archives of Neurology. 1989 Oct 1;46(10):1098.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eScheel-Sailer A, Post MW, Michel F, Weidmann‐H\u0026uuml;gle T, Baumann H\u0026ouml;lzle R. Patients\u0026rsquo; views on their decision making during inpatient rehabilitation after newly acquired spinal cord injury\u0026mdash;A qualitative interview‐based study. Health Expectations : An International Journal of Public Participation in Health Care and Health Policy [Internet]. 2017 Oct 1;20(5):1133\u0026ndash;42. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5600242/\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eEuropean Spinal Cord Injury Federation. ESCIF Policy statement on the treatment, rehabilitation and life-long care of persons with spinal cord injuries (SCI). 2008. [Accessed 27 March 2022]. Available from: http://www.escif.org/ESCIFpolicy_statement.htm\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBraaf SC, Lennox A, Nunn A, Gabbe BJ. Experiences of hospital readmission and receiving formal carer services following spinal cord injury: a qualitative study to identify needs. Disability and Rehabilitation. 2017 Apr 14;40(16):1893\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMcColl MA, Aiken A, McColl A, Sakakibara B, Smith K. Primary care of people with spinal cord injury: scoping review. Canadian Family Physician Medecin De Famille Canadien [Internet]. 2012 Nov 1 [cited 2024 Mar 27];58(11):1207\u0026ndash;16, e626-635. Available from: https://pubmed.ncbi.nlm.nih.gov/23152456/\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKinnett-Hopkins D, Mummidisetty CK, Ehrlich-Jones L, Crown D, Bond RA, Applebaum MH, et al. Users with spinal cord injury experience of robotic Locomotor exoskeletons: a qualitative study of the benefits, limitations, and recommendations. Journal of NeuroEngineering and Rehabilitation. 2020 Sep 11;17(1).\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eGagnon DH, Vermette M, Duclos C, Aubertin-Leheudre M, Ahmed S, Kairy D. Satisfaction and perceptions of long-term manual wheelchair users with a spinal cord injury upon completion of a locomotor training program with an overground robotic exoskeleton. Disability and Rehabilitation: Assistive Technology. 2017 Dec 19;14(2):138\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eFazekas G, Tavaszi I. The future role of robots in neuro-rehabilitation. Expert Review of Neurotherapeutics. 2019 May 15;19(6):471\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMorone G, Paolucci S, Cherubini A, De Angelis D, Venturiero V, Coiro P, et al. Robot-assisted gait training for stroke patients: current state of the art and perspectives of robotics. Neuropsychiatric Disease and Treatment [Internet]. 2017 May;Volume 13:1303\u0026ndash;11. Available from: https://www.dovepress.com/robot-assisted-gait-training-for-stroke-patients-current-state-of-the--peer-reviewed-fulltext-article-NDT.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eFabbri I, Betti F, Tedeschi R. Gait quality after robot therapy compared with physiotherapy in the patient with incomplete spinal cord injured: A systematic review. eNeurologicalSci [Internet]. 2023 Jun 1 [cited 2023 Aug 24];31:100467. Available from: https://www.sciencedirect.com/science/article/pii/S2405650223000254?via%3Dihub\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLohse KR, Hilderman CGE, Cheung KL, Tatla S, Van der Loos HFM. Virtual Reality Therapy for Adults Post-Stroke: A Systematic Review and Meta-Analysis Exploring Virtual Environments and Commercial Games in Therapy. Quinn TJ, editor. PLoS ONE [Internet]. 2014 Mar 28;9(3):e93318. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969329/\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKu JH. The management of neurogenic bladder and quality of life in spinal cord injury. BJU International. 2006 Oct;98(4):739\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eAl Taweel W, Seyam R. Neurogenic bladder in spinal cord injury patients. Research and Reports in Urology. 2015 Jun;7:85.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eOzisler Z, Koklu K, Ozel S, Unsal-Delialioglu S. Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction. Neural Regeneration Research. 2015;10(7):1153.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eTure SD, Ozkaya G, Sivrioglu K. Relationship between neurogenic bowel dysfunction severity and functional status, depression, and quality of life in individuals with spinal cord injury. The Journal of Spinal Cord Medicine. 2022 Feb 2;1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eNew PW, Seddon M, Redpath C, Currie KE, Warren N. Recommendations for spinal rehabilitation professionals regarding sexual education needs and preferences of people with spinal cord dysfunction: a mixed-methods study. Spinal Cord. 2016 May 10;54(12):1203\u0026ndash;9\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eAkman RY, \u0026Ccedil;elik EC, Karataş M. Sexuality and sexual dysfunction in spinal cord-injured men in Turkey. Turkish Journal of Medical Sciences [Internet]. 2015 Jan 1 [cited 2023 May 11];45(4):758\u0026ndash;61. Available from: https://journals.tubitak.gov.tr/medical/vol45/iss4/3/\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eCelik EC, Akman Y, Kose P, Arioglu P, Karatas M, Erhan B. Sexual problems of women with spinal cord injury in Turkey. Spinal Cord. 2014 Jan 14;52(4):313\u0026ndash;5\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"spinal-cord","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"sc","sideBox":"Learn more about [Spinal Cord](http://www.nature.com/sc/)","snPcode":"41393","submissionUrl":"https://mts-sc.nature.com/cgi-bin/main.plex","title":"Spinal Cord","twitterHandle":"@journalsci","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4180742/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4180742/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study aimed to understand the needs and expectations of individuals with disabilities caused by spinal cord injuries who require long-term rehabilitation from a rehabilitation hospital.\u003c/p\u003e \u003cp\u003eThe cross-sectional clinical study was conducted, which included individuals over the age of 18 with spinal cord injuries who had previously been hospitalized in a rehabilitation hospital. The 16-question survey, titled \"What should a rehabilitation hospital be like according to patients with spinal cord injuries,\" was applied to individuals hospitalized in the inpatient service of \u0026Ccedil;am Sakura City Hospital. It was also given to spinal cord injured people reached through social media. The participants' demographic data was recorded, and the survey was completed by 120 participants, comprising 70 males and 50 females. The mean age was 37.47\u0026thinsp;\u0026plusmn;\u0026thinsp;11.63 years, with 79 participants being married and 41 being single. Twenty-five participants had graduated from at least one university. The time since the spinal cord injury was less than two years for 20 individuals and more than two years for 100 individuals.\u003c/p\u003e \u003cp\u003eThe results showed that robotic rehabilitation and psychological support were the most requested rehabilitation elements, while interest in sexual rehabilitation was less than other rehabilitation elements. Furthermore, in the correlation analysis, elderly participants indicated that there should be more specialized services and outpatient clinics.\u003c/p\u003e \u003cp\u003eThis study highlights the importance of considering the needs and wishes of patients when planning and operating a rehabilitation center. The study clarifies that patients' needs for specialized services and robotic rehabilitation were striking. Additionally, the significance and necessity of sexual rehabilitation should be conveyed to patients.\u003c/p\u003e","manuscriptTitle":"Priorities of Patients with Spinal Cord Injury in Different Aspects of Rehabilitation in Turkiye","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-18 03:08:24","doi":"10.21203/rs.3.rs-4180742/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2024-06-13T10:06:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2024-05-15T00:21:56+00:00","index":1,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2024-05-10T08:11:44+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2024-05-04T06:36:36+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2024-04-22T12:21:11+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2024-04-15T00:55:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-02T10:08:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"Spinal Cord","date":"2024-03-28T14:00:43+00:00","index":"","fulltext":""},{"type":"checksFailed","content":"","date":"2024-03-28T13:26:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-28T08:31:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"spinal-cord","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"sc","sideBox":"Learn more about [Spinal Cord](http://www.nature.com/sc/)","snPcode":"41393","submissionUrl":"https://mts-sc.nature.com/cgi-bin/main.plex","title":"Spinal Cord","twitterHandle":"@journalsci","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"437b6664-244d-408c-9d63-858e15cf1330","owner":[],"postedDate":"April 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":30661738,"name":"Health sciences/Diseases/Neurological disorders/Spinal cord diseases"},{"id":30661739,"name":"Health sciences/Health care/Health services/Rehabilitation"},{"id":30661740,"name":"Health sciences/Health care/Health policy"}],"tags":[],"updatedAt":"2024-11-16T08:08:07+00:00","versionOfRecord":{"articleIdentity":"rs-4180742","link":"https://doi.org/10.1038/s41393-024-01049-7","journal":{"identity":"spinal-cord","isVorOnly":false,"title":"Spinal Cord"},"publishedOn":"2024-11-15 05:00:00","publishedOnDateReadable":"November 15th, 2024"},"versionCreatedAt":"2024-04-18 03:08:24","video":"","vorDoi":"10.1038/s41393-024-01049-7","vorDoiUrl":"https://doi.org/10.1038/s41393-024-01049-7","workflowStages":[]},"version":"v1","identity":"rs-4180742","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4180742","identity":"rs-4180742","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}