Efficacy of Self-management among Community-Dwelling Persons with Spinal Cord Injury : A Systematic Review

[Abstract] Background: Self-management after spinal cord injury (SCI) is a key prevention strategy for averting the development and recurrence of secondary complications and their associated consequences. In order to develop a socio-culturally appropriate self-management program, examination of the efficacy of existing programs is necessary. Objective: To review the efficacy of self-management interventions among community-dwelling persons with SCI. Method: We systematically searched four electronic databases [Scopus, EBSCOhost (CINAHL, MEDLINE), Web of Science, and PubMed] and bibliographies for relevant studies published between 2000 and 2019. The review process followed the PRISMA guidelines. Results: Of the initial 1,854 identified articles, 16 met selection criteria and were reviewed. Twelve self-management interventions (SMIs) among sixteen were found to have positive effects on at least one primary outcome. Positive physical health outcomes were good health state and reduction in secondary health complications. Emotional/psychosocial outcomes included improvements in self-efficacy, confidence to manage/prevent secondary health complications, life satisfaction, coping, decreased anxiety and depression. Positive role management outcomes were decreased activity limitations and increased participation. The efficacy of the SMIs did not appear to vary significantly by nature and delivery method of the interventions. Conclusion: The present review found that SMIs were effective for improving physical and emotional outcomes in most studies and role management in several studies. Our findings may aid future SMI development and research to focus more on role management, social barriers, and rights for persons with SCI in the community, especially in lower-middle-income countries, where community support and self-management programs rarely exist.