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Organisation of services and systems of care in paediatric spinal cord injury rehabilitation in seven countries: a survey with a descriptive cross-sectional design


Study design

International multicentre cross-sectional study.


To describe the organisation and systems of paediatric spinal cord injury (SCI) rehabilitation services in seven countries and compare them with available recommendations and key features of paediatric SCI.


Ten SCI rehabilitation units in seven countries admitting children and adolescents with SCI < 18 years of age.


An online survey reporting data from 2017. Descriptive and qualitative analysis were used to describe the data.


The units reported large variations in catchment area, paediatric population and referrals, but similar challenges in discharge policy. Nine of the units were publicly funded. Three units had a paediatric SCI unit. The most frequent causes of traumatic injury were motor vehicle accidents, falls, and sports accidents. Unlike the other units, the Chinese units reported acrobatic dancing as a major cause. Mean length of stay in primary rehabilitation ranged between 18 and 203 days. Seven units offered life-long follow-up. There was a notable variation in staffing between the units; some of the teams were not optimal regarding the interdisciplinary and multiprofessional nature of the field. Eight units followed acknowledged standards and recommendations for specialised paediatric SCI rehabilitation and focused on family-centred care and rehabilitation as a dynamic process adapting to the child and the family.


As anticipated, we found differences in the organisation and administration of rehabilitation services for paediatric SCI in the ten rehabilitation units in seven countries. This might indicate a need for internationally approved, evidence-based guidelines for specialised paediatric SCI rehabilitation.

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Fig. 1: Flowchart of survey data collection on paediatric spinal cord injury rehabilitation.
Fig. 2: The main principles in paediatric spinal cord injury rehabilitation are shown here.

Data availability

The questionnaire used in the study is available as supplementary material. The data generated and analysed during the current study are available from the corresponding author upon reasonable request, after ethical considerations.


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The authors wish to acknowledge Per-Ola Rike and Kirsti Riiser for their contribution to the study. Special thanks to the following for valuable support: Einar Magnus Strand, Li Jian Jun, Steven Flanegan, Edmund Shehadeh, Arkadi Rutgayzer, Amichai Brezner and Ofer Keren.


The study has received research grant funding after competitive peer review from the following sources: The South-Eastern Norway Regional Health Authority, The Ministry of Health and Care Services in Norway (HOD), Sunnaas Rehabilitation Hospital, and the participating units. The funding agencies did not influence the study design, data analysis or interpretation.

Author information




KSR, SS, VJ and JKS substantially contributed to the conception of the study. KSR, SS, VJ, WH, MA and JKS contributed to development of the study design. All authors critically revised the data collection instrument. KSR and SS led the data collection. WH and KSR prepared the manuscript and led the data analysis. WH, KSR, SS, VJ, MA and JKS substantially contributed to data interpretation and manuscript revision. All authors participated in critically revising the manuscript and have read and approved the final manuscript.

Corresponding author

Correspondence to Wiebke Höfers.

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Competing interests

The authors declare no competing interests.

Ethical approval

Ethical approval was obtained from local ethical committees for all the participating clinics and from the Regional Ethics Committee of Health South-East Norway (2017/1867; 21. December 2017, 3. April 2019, 26. May 2020) for this project. The study is registered in, 12 June 2018, NCT04117854.

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Höfers, W., Jørgensen, V., Sällström, S. et al. Organisation of services and systems of care in paediatric spinal cord injury rehabilitation in seven countries: a survey with a descriptive cross-sectional design. Spinal Cord (2021).

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