Prevalence of and factors associated with expressed and unmet service needs reported by persons with spinal cord injury living in the community


Study design

Observational study.


To determine the prevalence, predictors, and consequences of self-reported service needs among community-dwelling persons with SCI.


Community-based, Switzerland.


Participants were 490 people who took part in the health services module of the Swiss Spinal Cord Injury Cohort Study (SwiSCI) 2012 community survey. We determined the prevalence of 20 service needs and the extent to which they were unmet. Predictors and consequences of service needs were examined with multiple regression analyses.


High-prevalence needs (e.g., general health care, accessible housing) exhibited a high level of fulfillment. Conversely, less prevalent service needs (e.g., peer support, support for family caregivers) showed lower levels of fulfillment. Across three specific service domains (peer support, support for family caregivers, sports activities), lower household income predicted most consistently a higher likelihood of unmet needs. The total number of expressed needs was higher in non-Swiss nationals, persons with complete para- or tetraplegia and lower income individuals. Being female, French language region and lower household income predicted more total unmet needs. Increased expressed and unmet service needs were associated with lower life satisfaction.


Service needs with a high prevalence seem to be adequately met by the current service provision system. However, rehabilitation professionals should remain alert to clients’ specific and cumulative unmet needs, in particular with respect to less common ones, and their impact on successful community reintegration and life satisfaction.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1
Fig. 2


  1. 1.

    United Nations. Convention on the rights of persons with disabilities. Accessed 20 Jan 2018.

  2. 2.

    WHO. World report on disability. Geneva: World Health Organization; 2011.

  3. 3.

    Lukersmith S (ed). Guidance on the support needs for adults with spinal cord injury. Sydney: icare (Insurance and Care NSW); 2017.

  4. 4.

    Moreno A, Zidarov D, Raju C, Boruff J, Ahmed S. Integrating the perspectives of individuals with spinal cord injuries, their family caregivers and healthcare professionals from the time of rehabilitation admission to community reintegration: protocol for a scoping study on SCI needs. BMJ Open. 2017; 7.

  5. 5.

    Bickenbach J, Officer A, Shakespeare T, von Groote P (eds). International perspectives on spinal cord injury. Geneva: World Health Organization, International Spinal Cord Society; 2013.

  6. 6.

    Cox RJ, Amsters DI, Pershouse KJ. The need for a multidisciplinary outreach service for people with spinal cord injury living in the community. Clin Rehabil. 2001;15:600–6.

  7. 7.

    Kennedy P, Sherlock O, McClelland M, Short D, Royle J, Wilson C. A multi-centre study of the community needs of people with spinal cord injuries: the first 18 months. Spinal Cord. 2010;48:15–20.

  8. 8.

    Van Loo MA, Post MW, Bloemen JH, van Asbeck FW. Care needs of persons with long-term spinal cord injury living at home in the Netherlands. Spinal Cord. 2010;48:423–8.

  9. 9.

    Post MW, van Asbeck FW, van Dijk AJ, Schrijvers AJ. Services for spinal cord injured: availability and satisfaction. Spinal Cord. 1997;35:109–15.

  10. 10.

    Biering-Sørensen F, Hansen RB, Biering-Sørensen J. Mobility aids and transport possibilities 10-45 years after spinal cord injury. Spinal Cord. 2004;42:699–706.

  11. 11.

    Biering-Sørensen T, Hansen RB, Biering-Sørensen F. Home aids and personal assistance 10-45 years after spinal cord injury. Spinal Cord. 2009;47:405–12.

  12. 12.

    Noreau L, Noonan VK, Cobb J, Leblond J, Dumont FS. Spinal cord injury community survey: understanding the needs of Canadians with SCI. Top Spinal Cord Inj Rehabil. 2014;20:265–76.

  13. 13.

    Noreau L, Noonan VK, Cobb J, Leblond J, Dumont FS. Spinal cord injury community survey: a national, comprehensive study to portray the lives of Canadians with spinal cord injury. Top Spinal Cord Inj Rehabil. 2014;20:249–64.

  14. 14.

    Hertig-Godeschalk A, Gemperli A, Arnet U, Hinrichs T. Availability and need of home adaptations for personal mobility among individuals with spinal cord injury. J Spinal Cord Med. 2018;41:91–101.

  15. 15.

    Donnelly C, McColl MA, Charlifue S, Glass C, O’Brien P, Savic G, et al. Utilization, access and satisfaction with primary care among people with spinal cord injuries: a comparison of three countries. Spinal Cord. 2007;45:25–36.

  16. 16.

    Sweet SN, Noreau L, Leblond J, Dumont FS. Understanding quality of life in adults with spinal cord injury via SCI-related needs and secondary complications. Top Spinal Cord Inj Rehabil. 2014;20:321–8.

  17. 17.

    Kennedy P, Lude P, Taylor N. Quality of life, social participation, appraisals and coping post spinal cord injury: a review of four community samples. Spinal Cord. 2006;44:95–105.

  18. 18.

    Brinkhof MW, Fekete C, Chamberlain JD, Post MW, Gemperli A. Swiss national community survey on functioning after spinal cord injury: Protocol, characteristics of participants and determinants of non-response. J Rehabil Med. 2016;48:120–30.

  19. 19.

    FORS. Swiss Household Panel, wave 14 (individual questionnaire). Lausanne: FORS; 2012.

  20. 20.

    Brown LD, Cai TT, DasGupta A. Interval estimation for a binomial proportion. Stat Sci. 2001;16:101–33.

  21. 21.

    Hodgetts S, Zwaigenbaum L, Nicholas D. Profile and predictors of service needs for families of children with autism spectrum disorders. Autism. 2015;19:673–83.

  22. 22.

    Stekhoven DJ, Bühlmann P. MissForest—non-parametric missing value imputation for mixed-type data. Bioinformatics. 2012;28:112–8.

  23. 23.

    Beauregard L, Guindon A, Noreau L, Lefebvre H, Boucher N. Community needs of people living with spinal cord injury and their family. Top Spinal Cord Inj Rehabil. 2012;18:122–5.

  24. 24.

    Ronca E, Scheel-Sailer A, Koch HG, Gemperli A. Health care utilization in persons with spinal cord injury: part 2—determinants, geographic variation and comparison with the general population. Spinal Cord. 2017;55:828.

  25. 25.

    Sweet SN, Noreau L, Leblond J, Martin Ginis KA. Peer support need fulfillment among adults with spinal cord injury: relationships with participation, life satisfaction and individual characteristics. Disabil Rehabil. 2016;38:558–65.

  26. 26.

    Heinemann AW, Sokol K, Garvin L, Bode RK. Measuring unmet needs and services among persons with traumatic brain injury. Arch Phys Med Rehabil. 2002;83:1052–9.

  27. 27.

    Schulz-Heik RJ, Poole JH, Dahdah MN, Sullivan C, Adamson MM, Date ES, et al. Service needs and barriers to care five or more years after moderate to severe TBI among Veterans. Brain Inj. 2017;31:1287–93.

  28. 28.

    Hansen DG, Larsen PV, Holm LV, Rottmann N, Bergholdt SH, Søndergaard J. Association between unmet needs and quality of life of cancer patients: a population-based study. Acta Oncol. 2013;52:391–9.

Download references


We are grateful to all the participants of the SwiSCI survey for their time and effort spent in responding to the questions. We further thank the personnel of the SwiSCI study center and the SwiSCI Steering Committee whose members are: Xavier Jordan, Bertrand Léger (Clinique Romande de Réadaptation, Sion); Michael Baumberger, Hans Peter Gmünder (Swiss Paraplegic Center, Nottwil); Armin Curt, Martin Schubert (University Clinic Balgrist, Zürich); Margret Hund-Georgiadis, Kerstin Hug (REHAB Basel, Basel); Thomas Troger (Swiss Paraplegic Association, Nottwil); Daniel Joggi (Swiss Paraplegic Foundation, Nottwil); Hardy Landolt (Representative of persons with SCI, Glarus); Nadja Münzel (Parahelp, Nottwil); Mirjam Brach, Gerold Stucki (Swiss Paraplegic Research, Nottwil); Christine Fekete (SwiSCI Coordination Group at Swiss Paraplegic Research, Nottwil).


The study was financed in the framework of the Swiss Spinal Cord Injury Cohort Study (SwiSCI,, supported by the Swiss Paraplegic Foundation.

Author contributions

BT, MB, and MP designed the study. BT conducted the data analysis and prepared the article. AG, MB and MP contributed to the data interpretation and article preparation.

Author information




Corresponding author

Correspondence to Bruno Trezzini.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the ethics committees of the four Swiss cantons with SCI-specialized centers (Lucerne, Zurich, Basel-Stadt and Valais) [18].

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Trezzini, B., Brach, M., Post, M. et al. Prevalence of and factors associated with expressed and unmet service needs reported by persons with spinal cord injury living in the community. Spinal Cord 57, 490–500 (2019).

Download citation

Further reading