Living with spinal cord injury in the community of Bangladesh: a comprehensive analysis using the ICF framework

Authors

DOI:

https://doi.org/10.2340/jrm.v58.44856

Keywords:

Activities of Daily Living, Environment, International Classification of Functioning, Disability and Health, Personal Autonomy, Quality of Life, Social Participation, SCI

Abstract

Objective: To describe limitations in functioning (activities and participation) and environmental and personal factors that are associated with functioning using the ICF framework among persons living with spinal cord injury in the community of Bangladesh.

Design: Cross-sectional study, Bangladesh arm of the International Spinal Cord Injury (InSCI) Community Survey (2023–2024).

Subjects/Patients: 789 individuals with spinal cord injury.

Methods: Face-to-face interview through culturally adapted InSCI questionnaires. Generalized linear models were used to determine the associated factors.

Results: Participants were predominantly male (73%), aged 18–40 years (51%), and from rural areas (63%). More than one-third had tetraplegia (34%). Tetraplegic participants reported greater limitations across all ICF domains compared with paraplegics (all p <  0.01). Determinants of poorer outcomes included male sex, younger age, low education, rural residence, and severe injury of all ICF domains.

Conclusion: Individuals with spinal cord injury in Bangladesh face severe restrictions in functioning and participation, shaped by sociodemographic and clinical factors. These findings echo global evidence from other InSCI countries and LMIC studies, highlighting systemic barriers common to resource-constrained settings. Addressing these disparities through accessible rehabilitation, policy reforms, and cross-national knowledge exchange is critical to advancing equitable spinal cord injury care worldwide.

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References

Safdarian M, Trinka E, Rahimi-Movaghar V, Thomschewski A, Aali A, Abady GG, et al. Global, regional, and national burden of spinal cord injury, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2023; 22: 1026–1047. DOI: https://doi.org/10.1016/S1474-4422(23)00287-9

Covell MM, Naik A, Shaffer A, Cramer SW, Alan N, Shabani HK, et al. Social determinants of health impact spinal cord injury outcomes in low- and middle-income countries: a meta-epidemiological study. Neurosurgery 2023; 94: 893–902. DOI: https://doi.org/10.1227/neu.0000000000002765

Uddin T, Islam MT, Hossain M, Hossain MS, Salek AKM, Islam MJ, et al. Demographic and clinical characteristics of persons with spinal cord injury in Bangladesh: database for the International Spinal Cord Injury Community Survey 2023. Neurotrauma Rep 2023; 4: 598–604. DOI: https://doi.org/10.1089/neur.2023.0040

Hossain MS, Rahman MA, Bowden JL, Quadir MM, Herbert RD, Harvey LA. Psychological and socioeconomic status, complications and quality of life in people with spinal cord injuries after discharge from hospital in Bangladesh: a cohort study. Spinal Cord 2016; 54: 483–489. DOI: https://doi.org/10.1038/sc.2015.179

Bickenbach J, Officer A, Shakespeare T, von Groote P, Organization WH, Society TISC. International perspectives on spinal cord injury [Serial on the Internet]. World Health Organization; 2013 [cited 2025 June 24]. Available from: https://iris.who.int/handle/10665/94190

Uddin T, Siddiquee N, Rahman MA, Helal SU, Kiekens C. Rehabilitation of persons with spinal cord injury in Bangladesh. Mymensingh Med J 2022; 31: 1093–1101.

World Health Organization. Rehabilitation [Serial on the Internet]. Geneva: World Health Organization; 2024 [cited 2026 Apr 1]. Available from: https://www.who.int/news-room/fact-sheets/detail/rehabilitation

Donovan WH. Donald Munro Lecture. Spinal cord injury: past, present, and future. J Spinal Cord Med 2007; 30: 85–100. DOI: https://doi.org/10.1080/10790268.2007.11753918

Krause JS, Newman SD. Clinical outcomes after spinal cord injury. In: Handbook of neurochemistry and molecular neurobiology [Serial on the Internet]. Boston, MA: Springer; 2009 [cited 2026 Apr 1], p. 615–632. DOI: https://doi.org/10.1007/978-0-387-30375-8_27

World Health Organization. International Classification of Functioning, Disability and Health [Serial on the Internet]. Geneva: World Health Organization; 2001 [cited 2025 June 25]. Available from: https://iris.who.int/bitstream/handle/10665/42407/9241545429.pdf?sequence=1

Leonardi M, Lee H, Kostanjsek N, Fornari A, Raggi A, Martinuzzi A, et al. 20 Years of ICF – International Classification of Functioning, Disability and Health: uses and applications around the world. IJERPH 2022; 19: 11321. DOI: https://doi.org/10.3390/ijerph191811321

Hossain MS, Islam MS, Rahman MA, Glinsky JV, Herbert RD, Ducharme S, et al. Health status, quality of life and socioeconomic situation of people with spinal cord injuries six years after discharge from a hospital in Bangladesh. Spinal Cord 2019; 57: 652–661. DOI: https://doi.org/10.1038/s41393-019-0261-9

Ahmed N, Quadir MM, Rahman MA, Alamgir H. Community integration and life satisfaction among individuals with spinal cord injury living in the community after receiving institutional care in Bangladesh. Disabil Rehabil 2018; 40: 1033–1040. DOI: https://doi.org/10.1080/09638288.2017.1283713

Gross-Hemmi MH, Post MWM, Ehrmann C, Fekete C, Hasnan N, Middleton JW, et al. Study protocol of the International Spinal Cord Injury (InSCI) Community Survey. Am J Phys Med Rehabil 2017; 96: S23–S34. DOI: https://doi.org/10.1097/PHM.0000000000000647

International Spinal Cord Society. International Spinal Cord Injury Survey [Serial on the Internet]. Switzerland: Swiss Paraplegic Research; 2017 May [cited 2026 Mar 20]. Available from: https://www.swisci.ch/images/InSCI/InSCI_Questionnaire.pdf

WHO. Brief Model Disability Survey (Brief MDS) [Serial on the Internet]. Geneva: World Health Organization and the World Bank; 2017 [cited 2015 July 17]. Available from: https://cdn.who.int/media/docs/default-source/documents/disability/disabilities-mds-implementation-guide-en.pdf?sfvrsn=c85872db_1

Fekete C, Eriks-Hoogland I, Baumberger M, Catz A, Itzkovich M, Lüthi H, et al. Development and validation of a self-report version of the Spinal Cord Independence Measure (SCIM III). Spinal Cord 2013; 51: 40–47. DOI: https://doi.org/10.1038/sc.2012.87

Ballert CS, Post MW, Brinkhof MW, Reinhardt JD, SwiSCI Study Group. Psychometric properties of the Nottwil Environmental Factors Inventory Short Form. Arch Phys Med Rehabil 2015; 96: 233–240. DOI: https://doi.org/10.1016/j.apmr.2014.09.004

WHO. Spinal cord injury [Serial on the Internet]. 2024 [cited 2026 Mar 22]. Available from: https://www.who.int/news-room/fact-sheets/detail/spinal-cord-injury

Kirchberger I, Biering-Sørensen F, Charlifue S, Baumberger M, Campbell R, Kovindha A, et al. Identification of the most common problems in functioning of individuals with spinal cord injury using the International Classification of Functioning, Disability and Health. Spinal Cord 2010; 48: 221–229. DOI: https://doi.org/10.1038/sc.2009.116

Urme SA, Ricky AS, Fahad AHM, Chowdhury S, Ferdous J. Biopsychosocial challenges of spinal cord injury survivors in Bangladesh: a qualitative investigation. BMC Public Health 2025; 25: 4129. DOI: https://doi.org/10.1186/s12889-025-25312-5

Budd MA, Gater DR, Channell I. Psychosocial consequences of spinal cord injury: a narrative review. J Pers Med 2022; 12: 1178. DOI: https://doi.org/10.3390/jpm12071178

Lijodi B, Titus A, Louw Q, Joseph C. Activity limitations, participation restrictions, and environmental barriers among persons with traumatic spinal cord injury in Kenya. Disabil Rehabil 2025; 47: 1156–1162. DOI: https://doi.org/10.1080/09638288.2024.2365413

Reinhardt JD, Middleton J, Bökel A, Kovindha A, Kyriakides A, Hajjioui A, et al. Environmental barriers experienced by people with spinal cord injury across 22 countries: results from a cross-sectional survey. Arch Phys Med Rehabil 2020; 101: 2144–2156. DOI: https://doi.org/10.1016/j.apmr.2020.04.027

Bhattarai M, Karki S, Baniya M, Dhakal R, Taylor HB. Understanding barriers to spinal cord injury rehabilitation services in Nepal: a qualitative study of rehabilitation professionals’ perspectives. Rehabil Psychol 2025; 70: 203–213. DOI: https://doi.org/10.1037/rep0000575

Middleton JW, Arora M, Kifley A, Clark J, Borg SJ, Tran Y, et al. Australian arm of the International Spinal Cord Injury (Aus-InSCI) Community Survey: 2. Understanding the lived experience in people with spinal cord injury. Spinal Cord 2022; 60: 1069–1079. DOI: https://doi.org/10.1038/s41393-022-00817-7

Noreau L, Noonan V, Cobb J, Leblond J, Dumont F. Spinal cord injury community survey: understanding the needs of Canadians with SCI. Top Spinal Cord Inj Rehabil 2014; 20: 265–276. DOI: https://doi.org/10.1310/sci2004-265

Craig A, Tran Y, Middleton J. Psychological morbidity and spinal cord injury: a systematic review. Spinal Cord 2009; 47: 108–114. DOI: https://doi.org/10.1038/sc.2008.115

Post MWM, Van Leeuwen CMC. Psychosocial issues in spinal cord injury: a review. Spinal Cord 2012; 50: 382–389. DOI: https://doi.org/10.1038/sc.2011.182

Lakhani A, Martin K, Gray L, Mallison J, Grimbeek P, Hollins I, et al. What is the impact of engaging with natural environments delivered via virtual reality on the psycho-emotional health of people with spinal cord injury receiving rehabilitation in hospital? Findings from a pilot randomized controlled trial. Arch Phys Med Rehabil 2020; 101: 1532–1540. DOI: https://doi.org/10.1016/j.apmr.2020.05.013

Middleton J, Tran Y, Craig A. Relationship between quality of life and self-efficacy in persons with spinal cord injuries. Arch Phys Med Rehabil 2007; 88: 1643–1648. DOI: https://doi.org/10.1016/j.apmr.2007.09.001

Chang F-H, Latham NK, Ni P, Jette AM. Does self-efficacy mediate functional change in older adults participating in an exercise program after hip fracture? A randomized controlled trial. Arch Phys Med Rehabil 2015; 96: 1014–1020.e1. DOI: https://doi.org/10.1016/j.apmr.2015.02.009

Loni E, Moein S, Bidhendi-Yarandi R, Akbarfahimi N, Layeghi F. Changes in functional independence after inpatient rehabilitation in patients with spinal cord injury: a simultaneous evaluation of prognostic factors. J Spinal Cord Med 2024; 47: 369–378. DOI: https://doi.org/10.1080/10790268.2022.2064264

Savic G, Frankel HL, Jamous MA, Soni BM, Charlifue S. Participation restriction and assistance needs in people with spinal cord injuries of more than 40 year duration. Spinal Cord Ser Cases 2018; 4: 28. DOI: https://doi.org/10.1038/s41394-018-0056-9

Deane KC, Kurapati N, Gill E, Vogel LC, Zebracki K. Rural–urban disparities in healthcare factors and long-term health outcomes in individuals with pediatric-onset spinal cord injury. Front Rehabil Sci 2023; 4: 1102441. DOI: https://doi.org/10.3389/fresc.2023.1102441

Glennie RA, Batke J, Fallah N, Cheng CL, Rivers CS, Noonan VK, et al. Rural and urban living in persons with spinal cord injury and comparing environmental barriers, their health, and quality-of-life outcomes. J Neurotrauma 2017; 34: 2877–2882. DOI: https://doi.org/10.1089/neu.2016.4931

Raguindin PF, Muka T, Glisic M. Sex and gender gap in spinal cord injury research: Focus on cardiometabolic diseases. A mini review. Maturitas 2021; 147: 14–18. DOI: https://doi.org/10.1016/j.maturitas.2021.03.004

Neill R, Shawar YR, Ashraf L, Das P, Champagne SN, Kautsar H, et al. Prioritizing rehabilitation in low- and middle-income country national health systems: a qualitative thematic synthesis and development of a policy framework. Int J Equity Health 2023; 22: 91. DOI: https://doi.org/10.1186/s12939-023-01896-5

Published

2026-06-23

How to Cite

Uddin, T., Islam, M. T., Bhuiyan, R., Tasnim, A., Hossain, M. S., & Haque, M. A. (2026). Living with spinal cord injury in the community of Bangladesh: a comprehensive analysis using the ICF framework. Journal of Rehabilitation Medicine, 58, jrm44856. https://doi.org/10.2340/jrm.v58.44856

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