Therapeutic patient education to promote occupational participation of adults with Spinal Cord Injury in pre-2023 war Gaza, Palestine: A feasibility study

Abstract

Introduction:  Therapeutic patient education could improve rehabilitation outcomes and promote occupational justice. This study evaluated the feasibility of the Activities of Daily Living Education Manual for Spinal Cord Injury (SADL-eM) for people with Spinal Cord Injury living in Gaza, Palestine.

Methodology: In 2020, a single-group prospective feasibility study was used with a criterion sample of 15 participants with Spinal Cord Injury (SCI) recruited from an inpatient rehabilitation setting discharge list. Four domains of feasibility were assessed: demand, implementation, practicality, and acceptability, with predetermined criteria for feasibility in each domain. The secondary outcome was the reliability of the outcome measures used.

Results: Demand for this therapeutic patient education intervention was high (88%). 30 of 43 statements were positive (70%). Two themes emerged: ‘Corresponding to my condition as an SCI’ and ‘Suggestions to improve the SADL-eM feasibility’. The therapeutic patient educational intervention feasibility was demonstrated by 60% recruitment, 100% adherence and zero% attrition rates. The reliability of the employed clinical tool outcome was low to very high (Cronbach Alpha: 0.43-0.97).

Conclusion: A feasibility study is essential before conducting a main randomised control trail to reduce threats of failure and improve the reliability of findings. The SADL-eM was a feasible therapeutic education tool for people with SCI living in Gaza before the 2023/2024 war on the Gaza Strip. It is likely to continue being an important (and possibly only) information source for Arabic-speaking people who sustain an SCI.

Implications for Occupational Therapy Practice

• Co-designed and culturally relevant therapeutic patient education tools are more likely to be accepted and used by PW-SCI. This feasibility study was essential before conducting the main RCT because it highlighted limitations for consideration when planning for the main study. The value of including the perspective of PW-SCI in evaluating the feasibility of this intervention was evident in the qualitative data collected and led to improved delivery of the SADL-eM intervention.
• Since rehabilitation services at most hospitals in the Gaza strip have been destroyed following the start of the October 2023 war on Gaza, this study also highlighted the need to develop a follow-up system for PW-SCI in the Gaza Strip to monitor their medical and functional status and ensure proper referral for ongoing community rehabilitation.
• The SCIM-SR-Ar shows promise as a tool for follow-up and monitoring of the functional status of Arabic-speaking people with SCI internationally.
• Sub-scales of the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) have been used with people of Muslim faith in previous research. Due to gendered differences, we found this tool to be an unreliable measure of participation in spiritual activities in Gaza.
• Our freely-available Arabic therapeutic patient education manual, co-designed in Gaza, may prove to be a valuable resource in post-war rehabilitation services.