Participation Education Intervention for People With SCI From LMIC: A Pilot Randomized Clinical Trial.
Moussa Kleib Abumostafa, Nicola Ann Plastow, Maggi Savin-Baden
Adding a participation education manual to standard inpatient rehabilitation for spinal cord injury did not improve daily-living scores more than rehabilitation alone.
Both groups improved over 6 weeks. This small Gaza pilot tests feasibility, not efficacy.
Key findings
1The primary outcome (SCIM-SR-Ar) showed no significant difference between the intervention and control groups after 6 weeks (p = 0.222), and the secondary outcome (SCIM-III) also showed no significant between-group difference (p = 0.263).
2Both groups improved over time: the total sample's SCIM-SR-Ar score rose by 16.06% and the SCIM-III score by 17.00% over 6 weeks of inpatient rehabilitation, with all three SCIM domains improving significantly in both groups.
3The authors acknowledge that the randomisation was biased in favour of the control group, which had significantly higher baseline SCIM scores and less disability than the intervention group, undermining the validity of the between-group comparison.
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What it does not show
Only 32 participants (16 per arm), well below the 90 needed for the planned full RCT. The authors state the randomisation was inappropriate: the control group had significantly higher baseline SCIM scores and less disability, biasing the comparison in favour of the control group. Recruitment took 13 months and 30 of 32 participants came from a single hospital (Hamad), limiting generalisability. Both groups were in the same department, creating risk of contamination and exposure bias; the self-rated SCIM-SR-Ar could also be influenced by participants' awareness of the study. The SCIM measures only self-care, respiration/sphincter, and mobility, which the authors acknowledge do not capture the full range of participation important to people with SCI in Gaza (leisure, employment, religious activity, intimate relationships). The religiousness subscales were developed for Christian populations and proved unsuitable for the Muslim participants; the authors recommend developing a culturally appropriate alternative. The intervention was added to standard care rather than compared with no care, so the contribution of the manual versus the rehabilitation programme cannot be separated. Participants chose which manual section to cover each session, which promoted person-centred care but reduced consistency of the intervention.
Declared interests
No funding was received for this manuscript. The authors declare no conflicts of interest.
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