What self-care behaviours are essential for people with spinal cord injury? A systematic review and meta-synthesis

To systematically identify, evaluate, and synthesise the qualitative literature on the self-care behaviours, skills, and strategies performed by individuals with spinal cord injury (SCI). The Joanna Briggs Institute (JBI) meta-aggregation method was followed. The search was conducted on five databases and limited to papers published from January 2000 to March 2020. Two independent reviewers screened, extracted the data from, and assessed the methodological quality of selected papers using the JBI qualitative assessment and critical appraisal instrument. Eleven qualitative papers were included. Three synthesised findings with a moderate level of confidence emerged from 90 findings: people with SCI perform self-directed or directed-by-other behaviours focused on their physical condition (i); and on their social life (ii); people with SCI perform self-directed behaviours focused on their emotional well-being (iii). Individuals with SCI are aware of their condition and incorporate self-care behaviours into their routine to maintain health and prevent complications. This meta-synthesis provides evidence on the self-care behaviours performed by people with SCI to prevent, control, and manage the physical, emotional, and social effects of their condition. These findings may help healthcare providers to understand the self-care process in SCI survivors and tailor educational programmes to their experiences.IMPLICATIONS FOR REHABILITATIONSCI survivors are directly responsible for their health and must reach their maximum level of independence by acquiring self-care behaviours and adjusting them over time.Self-care behaviours must be incorporated into SCI survivors’ daily routine to maintain their condition, promote their social participation, and prevent complications.Caregiver contributions to self-care should be given more value, as these are fundamental to maintain SCI survivors’ well-being and social participation. SCI survivors are directly responsible for their health and must reach their maximum level of independence by acquiring self-care behaviours and adjusting them over time. Self-care behaviours must be incorporated into SCI survivors’ daily routine to maintain their condition, promote their social participation, and prevent complications. Caregiver contributions to self-care should be given more value, as these are fundamental to maintain SCI survivors’ well-being and social participation.

本研究旨在系统识别、评估并综合脊髓损伤（spinal cord injury, SCI）患者所实施的自我照护行为、技能与策略相关的质性研究文献。本研究采用乔安娜·布里格斯研究所（Joanna Briggs Institute, JBI）提出的元整合方法开展研究。检索范围覆盖5个数据库，且限定文献发表时间为2000年1月至2020年3月。由2名独立评审员采用JBI质性研究评估与关键评价工具，对入选文献开展筛选、数据提取及方法学质量评价。最终纳入11篇质性研究文献。从90项原始研究结果中，整合得到3项中等可信度的综合结论：聚焦于自身躯体状况的自我导向或他人协助式自我照护行为（i）、聚焦于自身社交生活的照护行为（ii），以及聚焦于自身情绪健康的自我导向照护行为（iii）。脊髓损伤患者对自身病情具备清晰认知，并会将自我照护行为融入日常作息，以维持健康状态、预防并发症发生。本次元整合研究为脊髓损伤患者为预防、控制及管理病情带来的躯体、情绪及社交影响而采取的自我照护行为提供了实证依据。上述研究结果可帮助医疗服务人员更好地理解脊髓损伤幸存者的自我照护过程，并可依据其实际经历定制针对性的教育方案。

### 康复启示
脊髓损伤幸存者需对自身健康全权负责，需通过学习自我照护行为并随时间调整相关策略，以达到最高水平的独立生活能力。需将自我照护行为融入脊髓损伤幸存者的日常作息，以维持病情稳定、促进社会参与并预防并发症。照护者在自我照护过程中所做的贡献应得到更多重视，因其对维持脊髓损伤幸存者的健康福祉与社会参与至关重要。

脊髓损伤幸存者需对自身健康全权负责，需通过学习自我照护行为并随时间调整相关策略，以达到最高水平的独立生活能力。需将自我照护行为融入脊髓损伤幸存者的日常作息，以维持病情稳定、促进社会参与并预防并发症。照护者在自我照护过程中所做的贡献应得到更多重视，因其对维持脊髓损伤幸存者的健康福祉与社会参与至关重要。