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Active Rehabilitation for persons with spinal cord injury in Botswana – effects of a community peer-based programme


Study design:

Prospective cohort study with a repeated measures analysis.


To measure the effects of the Active Rehabilitation (AR) training programme for community-dwelling individuals with spinal cord injury (SCI) in Botswana on physical independence, wheelchair mobility, self-efficacy, life satisfaction, level of physical activity and community participation.


The inaugural AR training programme in Botswana, a community peer-based programme for people with SCI. The 10-day residential programme in Botswana was led by an international team of peer mentors and health professionals.


Participants with SCI (on average 4 years after injury) completed a survey comprising a battery of standardised outcome measures at three timepoints: at the start, on completion and at 5 months after the programme (n = 14). Participants also completed a practical wheelchair skills test at start and completion of the programme (n = 17).


Participants improved in the mobility subscale of the Spinal Cord Independence Measure Self Report on completion (p = 0.011, d = 0.85) and at 5-month follow-up (p = 0.005, d = 0.93) as compared to baseline. They also achieved moderate improvement in self-efficacy to manage their condition (physical function domain of Moorong Self-Efficacy Scale) and large improvements in wheelchair mobility as assessed through the Queensland Evaluation of Wheelchair Skills test and the Wheelchair Skills Test Questionnaire. All positive results were retained at 5-month follow-up.


Findings indicate that the peer-based programme AR can play an important role in promoting physical independence, wheelchair mobility and injury-management self-efficacy in community-dwelling individuals with SCI in Botswana.

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We thank all participants, peer mentors and non-disabled members of the team for their involvement in the study. We also thank Inka Lõfvenmark for providing feedback on the manuscript.

Author information

AD is the principal investigator and designed the study in collaboration with TT and SJ. AD conducted the data analysis and prepared the draft of the manuscript. KT was the programme organizer and collected data at follow-up; SJ contributed to data analysis; CH contributed to organising the programme; KS collected data at follow-up; TT collected data at start and completion, and contributed to data analysis. All authors contributed to the design of the study and ethics application. All authors reviewed the manuscript, provided comments and approved final version of the manuscript.

Statement of ethics

The study protocol was reviewed and approved by the Health Research and Development department, Ministry of Health in Botswana (HPDME 13/18/1). We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

Conflict of interest

The authors declare that they have no conflict of interest.

Correspondence to Anestis Divanoglou.

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