Evaluation of The effect of Self-Care Education on Quality of Life in People with Spinal Cord Injury

Spinal cord injury is usually debilitating and has many negative effects on the quality of life of people due to secondary complications. Therefore, improving the quality of life of people with spinal cord injury is one of the main priorities in the nursing profession. Also, educating self-care behaviors and obtaining information from nurses can be helpful for people with this problem. Self-care is also the most important form of primary care for chronic diseases in the health sector. The aim of this study was to determine the effect of self-care education on the quality of life of people with spinal cord injury referred to Khatam Ol-Anbia Hospital in Tehran.

The present study was a quasi-experimental study with a control group. 84 patients with spinal cord injury referred to Khatam Ol-Anbia Hospital in Tehran in the first 6 months of 2020 were selected through systematic random sampling and divided in two groups; an intervention group and a control group. The questionnaire used in this study is an abbreviated form of WHO Quality of Life Assessment Group. WHOQOL-BREF Introduction is a 26-item questionnaire that measures a person's overall quality of life. This questionnaire has four subscales and an overall score. These subscales include: physical health, mental health, social relationships, environmental health, and an overall score. The reliability of Quality of Life questionnaire was achieved through Cronbach's alpha which was equal to α= 0.79 and internal correlation coefficient was calculated for relative reliability which was equal to 0.85. After coordination with the officials of Khatam Ol-Anbia Hospital in Tehran, the researcher referred to the spinal cord injury wards and after introducing himself, explaining the nature and objective of the research, and the procedures to conduct the study to the ward staff, the patients, and their companions, received informed consent from the patients.The pre-test was performed for both groups and before the intervention, the questionnaires of demographic characteristics and WHO Quality of Life were completed by patients admitted to the spinal cord injury wards. Then, the intervention group was formed in the social network entitled "Self-care and spinal cord injuries" and in addition to the usual training, 30-session self-care training was conducted every day for 30 minutes which lasted a month. The training included description of the disease, complications of the disease, types of pharmacological and non-pharmacological treatments for disease control, self-care and its importance in rehabilitation, how to follow a proper diet, how to follow the prescribed medication and daily activities, exercise and physical activity, counseling and talking with friends, family and non- family support, the skills of how to change the position, transfer, increase performance and independence of patients with spinal cord injury.In this study, 42 patients participated in each group, and 4 patients in the intervention group and 2 in the control group were excluded from the study for reasons such as cancellation of cooperation, not completing the questionnaire in pre-test or post-test stages, not studying the material submitted for more than three sessions (according to the feedback, the daily review of message information, analyzing Read or Delivered option in the social network), and finally a total of 38 patients comprised the intervention group and 40 patients the control group. At first, the patients were asked not to post irrelevant material and to express their views if they had any questions or concerns about the training provided. Also, only routine trainings were performed for the control group. To perform the post-test, one month after the end of the educational intervention, the tools were completed again by the two groups. The post-test was performed for the patients who returned to the hospital and the spinal cord injury wards on time, but for other patients, the questionnaires were sent privately to the social network and were completed remotely. After the posttest, the educational booklet was given to the control group. In this research, educational content was prepared by referring to the available library resources and with the guidance of supervisors and consultants.The validity of the educational content was assessed qualitatively by a survey of 3 faculty members. After collecting data, the results were analyzed through descriptive and inferential tests such as Fisher's exact test, Chi-square, independent t-test, and paired t-test in SPSS 16.

The results indicated no difference between the two groups in terms of distribution of underlying variables. Comparison of quality of life showed that the quality of life in patients with spinal cord lesions was not statistically significant before and after the intervention (P >0.05) and also the quality of life in the two groups was improved after the intervention and a statistically significant difference was observed (P <0.001). Regarding the changes in quality of life score, the mean quality of life of patients with spinal cord injury before the intervention was 13.10 ± 14.57 in the intervention group and 13.43 ± 13.97 in the control group. One week after the intervention, the mean quality of life of patients with spinal cord injury was 22.38 ± 13.98 in the intervention group and 15 ± 14.48 in the control group.

The results indicate that self-care program training is effective in improving the quality of life of patients with spinal cord injury. According to the researcher, several factors affect the results, including the nature of the disease, involvement of all body systems, and difficult conditions (lack of definitive treatment, dependence on nurses and informal caregivers) that make it difficult to control the disease. On the other hand, environmental conditions and economic situation, as well as lack of easy access to some drugs may have been involved in assessing the quality of life of these patients. According to the results, the method used in the present study can be suggested to nurses as a simple, non-invasive, low-cost, and effective method in improving the quality of life of patients with spinal cord injury.