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

Everyone was interviewed once, so the study can show which problems go together but not what causes them. People who had fully recovered were left out of the analysis, which could make the overall picture look more disabling than it really is. Of 3,471 people identified from medical records, 2,075 were reached by telephone, 1,228 were interviewed and 789 were analysed. The people who could not be reached or were excluded are not described. The questionnaires were designed for people to fill in themselves but were read aloud by interviewers because many participants had little formal education. This can bias answers, especially for subjective questions like mood and confidence. The four standard scales have not been formally checked for use in Bangladesh, so how well they measure what they claim in this population is unknown. Only part of the ICF framework was covered, so the authors themselves call this a pragmatic rather than a comprehensive application of it.

The authors declare no conflicts of interest. The study was funded by Bangladesh Medical University (formerly Bangabandhu Sheikh Mujib Medical University).

A single survey cannot tell you what causes these problems or what helps. Do not read the worse outcomes in tetraplegia as evidence that one rehabilitation approach works better than another, and do not treat the authors' recommendations about spasticity control, pain management or peer support as tested here. Nobody in this study received an intervention and nobody was followed over time.