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The influence of psychological need on rehabilitation outcomes for people with spinal cord injury


Study design

Single-centre, retrospective study of people with a spinal cord injury or disorder (PwSCI/D) and identified psychological need.


To examine the effect of psychological need on rehabilitation outcomes.


National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, United Kingdom.


Self-reported data from the Stoke Mandeville Spinal Needs Assessment Checklist (SMS-NAC) were used to examine identified psychological need (characterised by referral for psychological treatment, or scoring above clinical threshold in admission psychometric measures) on SCI rehabilitation outcome domains. Participants were grouped according to whether they were referred, not referred, scored above or below clinical threshold.


234 participants were included (Mean age at injury (years) = 53, 70% Male, 29% tetraplegia, 38% paraplegia, 33% ASIA D). There was a significant improvement in outcome scores from admission to discharge across all domains irrespective of participant group, however individuals with identified psychological need scored lower across all rehabilitation domains than those without. While individuals with psychological need demonstrated longer rehabilitation stays, more frequent and longer discharge delays, they also showed comparatively greater rehabilitation improvements. Psychological screening measures were more effective at detecting psychological need than individuals identified via referral, and participants scoring above clinical threshold had poorest overall rehabilitation outcomes.


Individuals with psychological need have greater rehabilitation need and may require longer rehabilitation and benefit from additional discharge planning. Early, proactive psychometric screening can better facilitate improvements for delivering rehabilitation. Future research should consider specific contributing factors to psychological need, such as pre-existing mental health conditions or socio-demographic influences.

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Data availability

The data used in the current study are part of a standard clinical database which contains identifiable patient information and are therefore not publicly available. Pseudonymised data can be made available upon reasonable request to Buckinghamshire Healthcare NHS Trust.


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Thank you to the patients and staff of the National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, for completion of the standard clinical outcome tool (SMS-NAC) which comprised this research.

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Authors and Affiliations



MW was responsible for study design, extracting and analysing the data, and writing the report. JD was responsible for the study design, contributed to the interpretation of results and writing of the report, and had oversight into the final version and submission of the research. LG contributed to analysing the data, writing the report and the submission of the manuscript.

Corresponding author

Correspondence to Jane Duff.

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The authors declare no competing interests.

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The authors certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were adhered to during the course of this research.

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Wallace, M., Duff, J. & Grant, L.C. The influence of psychological need on rehabilitation outcomes for people with spinal cord injury. Spinal Cord 61, 83–92 (2023).

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