Management of Spinal Cord Injury in Tunisia: 2024 landscape and challenges

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Published Mar 30, 2025
https://doi.org/10.62438/tunismed.v103i4.5496
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Vol. 103 No. 4 (2025): Tunis Med Apr 2025

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Sana Salah
Department of Physical Medicine and Rehabilitation, Laboratoire Technologies et Imagerie Médicale LabTIM LR12ES06,Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
Helmi Ben Saad
Heart Failure (LR12SP09) Research Laboratory, Farhat Hached Hospital,University of Sousse, Tunisia
Rihab Moncer
Department of Physical Medicine and Rehabilitation, Sahloul University Hospital.Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
Mariem Gaddour
Department of Physical Medicine and Rehabilitation, Sahloul University Hospital.Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
Sonia Jemni
Department of Physical Medicine and Rehabilitation, Sahloul University Hospital.Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
Zohra Ben Salah Frih
Department of Physical Medicine and Rehabilitation, Fattouma Bourguiba University Hospital, Faculty of Medicine of Monastir, University of Monastir, Monastir , Tunisia

Abstract

Introduction: Spinal Cord Injury (SCI) is a pressing global health issue, with a notable increase in incidence in Tunisia primarily attributed to traffic accidents. The repercussions of SCI extend beyond physical impairments, significantly affecting patient mental health and quality of life, and pose substantial economic challenges.


Objectives:  This study aims to provide an in-depth analysis of the current landscape of SCI management in Tunisia, identifying key challenges faced by patients and healthcare providers while offering actionable recommendations for improvement.


Methods: A comprehensive review of existing literature was conducted to assess the SCI management framework in Tunisia. The study focused on evaluating the rehabilitation system, healthcare provider training, and the implementation of disability rights in the country, while identifying barriers to effective care.


Results: Findings indicate a critical shortage of specialized rehabilitation facilities, with only 13 out of 24 governorates of the country providing adequate services. Additionally, there is a significant lack of trained healthcare professionals and inconsistent application of disability rights. Social stigmas further complicate the situation, hindering access to comprehensive care for SCI patients. Conclusion:  To enhance SCI care in Tunisia, it is essential to expand rehabilitation services, improve healthcare providers training in disability management, and strengthen disability support systems. Implementing policy reforms, increasing data collection efforts, promoting research and peer support programs are vital steps toward addressing the multifaceted challenges of SCI management and improving the quality of life for affected individuals.

Keywords:

Community Health Services, Developing Countries, Health Policy, Patient Care Management, Rehabilitation Centers

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References

  1. - Burns AS, O’Connell C. The challenge of spinal cord injury care in the developing world. J Spinal Cord Med. 2012;35(1):3-8.
  2. - The 2019 Global Burden of Diseases (GBD) study. http://ghdx.healthdata.org/gbd-results-tool-2019 (Accessed September 2024)
  3. - Elshahidi MH, Monir NY, Elzhery MA, Sharaqi AA, Haedaya H, Awad BI, et al. Epidemiological Characteristics of Traumatic Spinal Cord Injury (TSCI) in the Middle-East and North-Africa (MENA) Region: A Systematic Review and Meta-Analysis. Bull Emerg Trauma. 2018;6(2):75-89. doi: 10.29252/beat-060201.
  4. - Liu Y, Yang X, He Z, Li J, Li Y, Wu Y, et al. Spinal cord injury: global burden from 1990 to 2019 and projections up to 2030 using Bayesian age-period-cohort analysis. Front. Neurol. 2023; 14:1304153. doi: 10.3389/fneur.2023.1304153
  5. - Gaddour M, Ouannes W, Frioui S, Salah S, Khachnaoui F, Jemni S. Traumatic versus non traumatic spinal cord injury: Characteristics and functional outcome in a Tunisian rehabilitation center. Junior Med Res. 2018 ; 1(2):12-21.
  6. - GBD Spinal Cord Injuries Collaborators. Global, regional, and national burden of spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2023 Nov;22(11):1026-1047. doi: 10.1016/S1474-4422(23)00287-9.
  7. - Pilusa S, Myezwa H, Potterton J. Views of health care users and providers: Solutions to improve the prevention of secondary health conditions among people with spinal cord injury, South Africa. Spinal Cord Ser Cases. 2022; 8:67
  8. - World Health Organization. (‎2001)‎. Classification internationale du fonctionnement, du Handicap et de la santé : CIF. Organisation mondiale de la Santé. https://iris.who.int/handle/10665/42418 (Accessed September 2024)
  9. - Bright T, Wallace S, Kuper H. A systematic review of access to rehabilitation for people with disabilities in low- and middle-income countries. Int J Environ Res Public Health. 2018 ;15(10):2165. doi: 10.3390/ijerph15102165.
  10. - Moncer R, Loubiri I, Melki S, Frigui S, Ouannes W, Ben Abdelaziz A, et al. An update on the access to inpatient rehabilitation facilities across Tunisia in 2023. Tunis Med. 2024;102(02):83-86.
  11. - United nations Committee on the Rights of Persons with Disabilities Combined second and third periodic reports submitted by Tunisia under article 35 of the Convention, due in 2018 docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=6QkG1d%2FPPRiCAqhKb7yhsvOO0RvDbzSfy057%2Flfh1RxwtI2ddFLcUh0JeSht4ehEJf2Ue4pTJ%2B1hycgi7pfGwkQIRtVemHP1RK0CcXKTL0z16UFOmiCGXyjrJcaHxBtT (Accessed September 2024)
  12. - Bloemen-Vrencken JH, de Witte LP, Post MW. Follow-up care for persons with spinal cord injury living in the community: a systematic review of interventions and their evaluation. Spinal Cord. 2005 ;43(8):462-75. doi: 10.1038/sj.sc.3101750.
  13. - Mouhli N, Maaoui R, Hfaidh M, Rahali H. Rehabilitation 2030. 25ème Congrès National de la Société Tunisienne de Médecine Physique, Rééducation et Réadaptation Fonctionnelle SOTUMER, 1er Congrès Nord-Africain de Médecine Physique et de Réadaptation. Hammamet 12-14 Mai 2023.
  14. - World Health Organisation 2030. Landmark resolution on strengthening rehabilitation in health systems https://www.who.int/fr/news-room/fact-sheets/detail/rehabilitation (Accessed September 2024)
  15. - Bessem Krifa. Gestion du handicap en Médecine de première ligne : état des lieux et perspectives. Thèse de Médecine soutenue le 02/06/2020 à la Faculté de Médecine de Monastir, Tunisie.
  16. - United nations. (2006). Convention on the Rights of Persons with Disabilities. https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-persons-disabilities (Accessed September 2024)
  17. - Constitution de la République Tunisienne du 27 janvier 2014, Article 48.
  18. - ESCIF Policy Statement on the treatment, rehabilitation and life-long care of persons with spinal cord injuries (SCI). approved and accepted by the ESCIF Assembly of Delegates on 26 April 2008 in Umag, Croatia. Policy Statement - European Spinal Cord Injury Federation (escif.org) (Accessed October 2024)
  19. - Gibson-Gill C, Mingo T. Primary Care in the Spinal Cord Injury Population: Things to Consider in the Ongoing Discussion. Curr Phys Med Rehabil Rep. 2023;11(1):74-85. doi: 10.1007/s40141-023-00379-6.
  20. - Sezer N, Akkuş S, Uğurlu FG. Chronic complications of spinal cord injury. World J Orthop. 2015; 18;6(1):24-33. doi: 10.5312/wjo.v6.i1.24.
  21. - Arenia A, Capeci W, Del Popolo G, Cassinis A, Fergnani F, De Palma L, et al. What we do and what we should do against malnutrition in Spinal Cord Injury: A position paper from Italian Spinal Cord Injury network rehabilitation centers. J Clin Med Res. 2024;16(4):138-54.
  22. - Carrard V, Kunz S, Peter C. Mental health, quality of life, self-efficacy, and social support of individuals living with spinal cord injury in Switzerland compared to that of the general population. Spinal Cord. 2021;59(4):398-409. doi: 10.1038/s41393-020-00582-5.
  23. - Van Diemen, T., Verberne, D.P.J., Koomen, P.S.J. Interdisciplinary follow-up clinic for people with spinal cord injury: a retrospective study of a carousel model. Spinal Cord Ser Cases. 2021; 7, 86. https://doi.org/10.1038/s41394-021-00451-0
  24. - Solomon RM, Dhakal R, Halpin SJ, Hariharan R, O’Connor RJ, Allsop M, et al. Telerehabilitation for individuals with spinal cord injury in low-and middle-income countries: a systematic review of the literature. Spinal Cord. 2022; 60:395-403. https://doi.org/10.1038/s41393-022-00797-8
  25. - Geneva World Health Organization. WHO guideline: recommendations on digital interventions for health system strengthening. 2019. https://www.who.int/publications/i/item/9789241550505# (Accessed October 2024)
  26. - Bernard RM, Seijas V, Davis M, Volkova A, Diviani N, Lüscher J, et al. Mobile health self-management support for Spinal Cord Injury: systematic literature review. JMIR Mhealth Uhealth. 2023 Apr 26;11:e42679. doi: 10.2196/42679
  27. - McLeod J, Davis CG. Community peer support among individuals living with spinal cord injury. J Health Psychol. 2023, 28(10) 943-55
  28. - Constand, M.K., MacDermid, J.C., Dal Bello-Haas, V. Scoping review of patient-centered care approaches in healthcare. BMC Health Serv Res. 2014 ; 14, 271. https://doi.org/10.1186/1472-6963-14-271
  29. - Silva FAR, Barbosa MA, Prudente COM, Morais LA, Moraes KL, Vila VSC, et al. Health literacy of people with spinal cord injury: a systematic review. Spinal Cord. 2023;61(8):409-14. doi: 10.1038/s41393-023-00903-4.
  30. - Arejan RH, Azadmanjir Z, Ghodsi Z, Dehghan HR, Sharif-Alhoseini M, Tabary M, et al. How can policymakers be encouraged to support people with spinal cord injury- scoping review. J Health Psychol. 2023;28(10):943-55.