How does the rehabilitation environment influence quality of life in people with newly acquired spinal cord injury or disorder during acute-inpatient rehabilitation? A mixed methods study.

CONTEXT/OBJECTIVES: To explore how the rehabilitation environment influences quality of life (QoL) during acute-inpatient rehabilitation after spinal cord injury (SCI). DESIGN: Mixed methods. SETTING: Specialized SCI Center. PARTICIPANTS: Individuals aged 18 or older with newly acquired SCI (N = 20). INTERVENTIONS: Not applicable. OUTCOME MEASURE: International SCI Quality of Life Basic Data Set (SCI QoL-BDS) with an extra item on environmental QoL and qualitative semi-structured face-to-face interviews. METHODS: Interviews were conducted at least three months after the onset of SCI and two weeks before discharge from acute inpatient rehabilitation. Interviews were audio-recorded, transcribed verbatim, coded, and analyzed according to thematic content analysis. RESULTS: Environment-related QoL was rated high (Mdn  =  9, IQR =    7-9) and strongly correlated with psychological health-related QoL. Interpersonal and physical environmental factors emerged as main themes from interviews examining influences on environment-related QoL. Participants reported higher QoL when healthcare providers were empathic, understanding, motivated, kind, optimistic, transparent, encouraging, attentive, respectful, and had a sense of humor. Empowering behaviors, such as involving patients in decision-making and including family members and friends in the rehabilitation process, also contributed to higher QoL. Institutional factors such as understaffing, noise, and lack of privacy lowered QoL, while physical environmental factors such as wheelchair accessibility, access to a meditation room, beautiful landscape, food quality, cleanliness, and accommodation increased QoL. CONCLUSION: Findings highlight the importance of client-centered care for QoL during acute-inpatient rehabilitation and psychosocial benefits of a rehabilitation environment design that includes wheelchair accessibility on rehabilitation grounds, proximity to nature, and a space for socializing.