In a review of specialized SCI centers, early transfer of the individual with SCI to an integrated multidisciplinary care center is recommended because it reduces the total length of stay, overall mortality, and the number and severity of complications [10]. In a multicenter study, it was found that patients with SCI were functionally better at the end of rehabilitation in specialized centers [11]. It has been shown that the environment and the approach of the rehabilitation team, as well as the accurate understanding of their current medical condition and possible prognosis, have an impact on the decisions made by individuals with SCI when dealing with the complex health problem they face [12]. In this study, we investigated patients' expectations from rehabilitation centers that will play a crucial role in their lives after the acute period. Although patients' medical expectations after rehabilitation and general hospital expectations have been investigated, no patient expectation studies have been conducted for specialized rehabilitation units as in our study.
European Spinal Cord Injury Federation recommends that individuals with SCI receive treatment from the acute stage and lifelong follow-up in specialized centers [13]. Additionally, with results similar to our study, individuals with SCI also prefer specialized centers [14]. In the study investigating the applications of individuals with SCI to specialized SCI outpatient clinics, it was found that more than half of 1294 patients (51%) went for annual check-ups. In our study, the majority of the patients (85.84%) responded that there should be a specialized outpatient clinic, while the older ones stated that there should be specialized units in both the inpatient and the outpatient clinic. It has also been reported that the needs of individuals with SCI are not adequately met in primary health care services [15]. Considering all these, we think that specialized SCI outpatient clinic services for routine checks should be increased.
In a meta-analysis of robotic rehabilitation conducted in 2020, which included 18 studies, it was stated that it could improve spasticity and walking ability in people with SCI. No significant change in pain was detected after robot-assisted walking training [16]. Although robotic rehabilitation satisfaction is quite satisfactory with a rate of 95% in patients with SCI, as technology advances, the functions of patients with SCI will increase with exoskeleton type robotic devices [17,18]. Most of the robots commercialized today are based on the basic idea that walking is an automatic subcortical ability [19]. However, this needs to be reconsidered in the near future from neuromechanical perspectives, and physiatrists need to determine appropriate treatment methods for the appropriate patient. In this study, 91% of the participants answered the robotic rehabilitation question that it should be. The participants were most interested in robotic rehabilitation. The superiority of robotic rehabilitation over classical rehabilitation is controversial in the literatüre [20]. In our country, studies are needed to determine whether robotic rehabilitation meets physician and patient expectations.
Virtual reality was the second type of therapy that participants most frequently selected as the "I have no idea" option. A review investigating the effects of virtual reality devices and movement-based game consoles such as the Wii in stroke rehabilitation reported that virtual reality contributed to functional results compared to traditional treatment, but no difference was detected with game consoles [21]. Considering that patients' knowledge is low, new technology treatments such as virtual reality can be introduced to patients and increase their motivation and gains in rehabilitation hospitals. Our study found that patients with longer rehabilitation periods were more willing to use new technologies such as virtual reality.
Neurogenic bladder is as important as physical movement in the quality of life of chronic SCI patients [22]. A specially prepared treatment should be planned to protect the upper urinary tract, support continence and prevent complications [23]. In our study, we expected patients with incontinence to be more interested in bladder rehabilitation, but no significant difference was detected. However the low number of negative answers to the bladder rehabilitation question, compared to other questions, suggests people had achieved awareness. Another important complication, neurogenic bowel disease, is seen in 80% of patients with SCI and has an impact on the quality of life [24,25]. No significant difference was found in the responses to bowel rehabilitation between patients who had sensation in the anal area and those who did not.
Participants chose "I have no idea" and "It definitely shouldn't be" most frequently for the sexual rehabilitation question than for any other question. It has been reported that sexual education and information are provided at low rates during the rehabilitation process of individuals with SCI, and while only 18% are satisfied, 36% are dissatisfied [26]. Sexuality can be a sensitive topic for disabled individuals, particularly in cultures where open discussion is discouraged. In countries like ours, sexual life is a life activity that should be hidden and not shared. Expressing the sexual problems of disabled individuals and expecting a solution are not requests that we, healthcare professionals, encounter frequently [27,28]. Further research is needed to determine whether SCI individuals prioritize sexual rehabilitation differently than other aspects of care, and how healthcare professionals can best support their individualized needs.
Limitations
Given the online survey format, a limitation of this study is the inability to establish clear correlations between specific questions and participants' clinical conditions.