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Adherence to long-term medical follow-up: a qualitative, experience-focused study of people with spinal cord injury - 12/01/22

Doi : 10.1016/j.rehab.2022.101629 
Marc Le Fort, MD, PhD 1, 2, , Chloé Lefèvre, MD, MSc 1, Pierre Kieny, MD 1, Brigitte Perrouin-Verbe, MD, PhD 1, Jean-François Ravaud, MD, PhD 2, 3
1 House of Social Sciences in Disability - School of Advanced Studies in Public Health (EHESP), 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France 
2 Neurological PMR department, University Hospital, 85, rue Saint-Jacques, 44093, Nantes cedex, France 
3 National Institute for Health and Medical research (INSERM), 101, rue de Tolbiac, 75654, cedex 13, France 

Corresponding author: Marc Le Fort
Sous presse. Manuscrit accepté. Disponible en ligne depuis le Wednesday 12 January 2022

Highlights

Questionnaires studying adherence to follow-up showed no specific profile of people with spinal cord injury.
Appropriation and modulation depend on a combination of major context-related factors.
Appropriation of the follow-up is directly related to individuals and their functioning.
Modulation of the follow-up is linked to patients and the specialized medical sphere.
The readiness of people with spinal cord injury is a central issue to implement prevention strategies.

Le texte complet de cet article est disponible en PDF.

Abstract

Background

Scientific evidence indicates the presence of secondary conditions (such as pressure ulcers) after spinal cord injury (SCI). Treatment methods focusing on the management of paraplegia and tetraplegia include systematic preventive follow-up. These advances have significantly improved the functional and vital prognosis of people with SCI, but some people may not have access to these specialized organizations or may not adhere closely to this medicalized vision. We used a narrative approach to explore the perceptions of people with SCI to better understand their adherence to follow-up.

Objectives

We aimed to determine the “common denominators” that lead to adherence or non-adherence to long-term follow-up after SCI.

Methods

People with SCI who had completed their first rehabilitation period for > 1 year were included with regard to 2 variables: 1) an actual medical follow-up or not and 2) a history of pressure ulcer or not. A review of the literature was used as preparation for semi-directive interviews, which were prospectively analysed by using qualitative analysis software. Thematic saturation was reached at 28 interviews, and 32 interviews were ultimately completed.

Result

Three main areas concerning participants’ perceptions emerged: people's readiness, appropriation and modulation of the systematic follow-up. We developed a broad conceptual framework representing follow-up and the promotion of the long-term health of people with SCI from their perspectives.

Conclusions

The medical environment should ensure that people with SCI are ready to actively consider the implementation of prevention strategies and should take into account their ability to establish their own truth, to integrate various life stages after SCI and to negotiate systematic follow-up. The implementation of data about functioning should be conducted using the concept of the Learning Health System.

Le texte complet de cet article est disponible en PDF.

Keywords : grounded theory, readiness, appropriation, therapeutic education, KABP model


Plan


 IDRCB no.: 2015-AOI1465-44


© 2022  Publié par Elsevier Masson SAS.
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