Determinants of disability adaptation following rehabilitation in individuals with spinal cord injury in Bangladesh: A 6-Month to 10-year post-injury analysis.

Abstract

A cross-sectional study design. This study explored how individuals with SCI in Bangladesh adapt to disability following rehabilitation and identified the key determinants that influence this adaptation. Adaptation to disability is a complex, ongoing process shaped by personal, social and cultural factors. While previous studies in Bangladesh have explored community reintegration and quality of life after spinal cord injury, none have specifically examined how individuals adapt to disability in the community following hospital discharge. Participants were recruited from the SCI follow-up database, consisting of individuals who completed their rehabilitation at the Centre for the Rehabilitation of the Paralysed (CRP) between June 2015 and May 2025, using cluster sampling across all eight divisions of Bangladesh. Data were collected through interviews using a combined questionnaire that included both semi-structured items and the validated Bangla versions of the structured WHODAS 2.0 and the Adaptation to Disability Scale-Revised (ADS-R). Among 210 adults, most participants (71.4%) showed medium adaptation, while 28.1% had low adaptation and only 0.5% had high adaptation. Poor adaptation was associated with complete injuries, tetraplegia, unemployment, pressure ulcers and delays in starting rehabilitation. Surprisingly, higher education did not always support emotional adjustment. Early rehabilitation, steady income and family support emerged as key enablers. Many individuals with SCI in Bangladesh continue to struggle with adaptation. Timely rehabilitation, emotional support, and better access to income-generating opportunities are vital for improving long-term adaptation to disability.