Primary care of people with spinal cord injury: scoping review

To perform a scoping review of the empirical evidence between 1980 and 2009 regarding primary care for adults with spinal cord injury (SCI).

Peer-reviewed journals were searched from 1980 to 2009 using CINAHL, PubMed-MEDLINE, EMBASE, PsycINFO, Social Sciences Abstracts, and Social Work Abstracts.

The key word-driven electronic search identified 42 articles on primary care and SCI. Inclusion criteria narrowed the set to 21 articles that were published in English, that had a sample size of greater than 3, and that offered empirical analysis.

Approximately 90% of people with SCI identify family physicians as their regular doctors; 63% have SCI specialists. People with long-term SCI develop complex rubrics for navigating their personal health care systems. There is conflicting evidence about the effectiveness of outreach programs for maintaining health and preventing complications following SCI. Regular follow-up by specialized teams and annual comprehensive health examination are supported by the evidence. The research shows a high level of consistency in identifying the most common issues raised by people with SCI in primary care, most of which are related to disability-specifically, secondary complications such as bowel or bladder dysfunction and pain. There is also good evidence that many general health issues require attention in this population, such as bone density problems, depression, and sexual and reproductive health issues. There is level 4 and 5 evidence for unmet health needs among individuals living with SCI in the community. Despite patients with SCI being high users of primary care and health services in general, the evidence suggests that the information needs of these patients in particular are poorly met.

A robust system of primary care is the best assurance of good health outcomes and reasonable health service use for people with SCI, including annual comprehensive examination, appropriate specialist use, and attention to accessibility and unmet needs.