Spinal cord injury quality of life linked to support and autonomy in Finland

A nationwide mixed-methods study of people living with spinal cord injury in Finland found that quality of life was associated with health, social support, autonomy, psychological adaptation, meaningful participation and the adequacy of health and social services. Injury severity itself was not independently associated with quality of life in the adjusted quantitative analysis. Interviews with 45 survey participants showed how secondary health conditions, restricted spontaneity and service barriers affected everyday life, while relationships, self-knowledge and a sense of control helped people maintain well-being despite persistent limitations.

The research combined a cross-sectional survey of 879 adults with spinal cord injury with semi-structured interviews conducted in 2019. Quality of life was assessed with one PROMIS Global Health question, Global02, using five response options from poor to excellent. Researchers used multivariable ordinal logistic regression to examine associations with sociodemographic and injury-related variables. The interviews, which produced almost 53 hours of recordings and 1,530 pages of transcript, were analyzed inductively and then compared with the survey results. The final regression sample included 876 participants after three records with missing model variables were excluded.

Overall quality of life was rated as fair, with a mean score of 2.6 and a standard deviation of 0.90 on the five-point response scale. Age was strongly associated with the ratings: compared with participants aged 76 years or older, those aged 16 to 30 had 5.68 times the odds of reporting better quality of life, while the corresponding odds were 4.55 for ages 31 to 45, 2.00 for ages 46 to 60 and 1.91 for ages 61 to 75. Female participants had 1.38 times the odds of reporting better quality of life than male participants. Living arrangement, injury cause and neurological severity category were not independently associated with quality of life after adjustment for the other model variables.

The absence of an independent association with neurological severity did not mean that spinal cord injury had no effect on daily life. Interviews showed that loss of physical function often required more advance planning, reduced spontaneity and increased dependence on assistance. These consequences were described through the experience of deciding where one could go, whether a toilet would be accessible, and how much time had to be devoted to bowel and bladder routines. Participants also described how pain, spasticity, sexual dysfunction and bladder or bowel dysfunction could restrict travel, work, relationships and social participation. In the integrated results, the consequences of injury appeared connected to quality of life through functioning, participation and personal control rather than through severity alone.

Secondary health conditions emerged as one of the clearest themes in the qualitative data. Participants said persistent pain could disrupt sleep, reduce daytime energy and worsen mood. Bladder and bowel problems created uncertainty because continence and regular catheterization affected whether they felt able to leave home. Sexual dysfunction was associated with distress about intimate relationships, self-image and mental well-being. The interviews also showed that mental health could fluctuate with the seasons, pain, general health, employment and unemployment. These accounts expanded the age pattern in the survey: the researchers suggested that differences in health, secondary conditions and opportunities for participation may help explain why younger respondents reported better quality of life, although the cross-sectional design cannot establish causation.

Autonomy and personally meaningful activity repeatedly emerged as resources. Participants valued the ability to make choices, care for their appearance, health and fitness, and influence their lives even when daily tasks required help. Work supplied routine, purpose and a sense of belonging, even when respondents described its financial value as limited. Continuing former hobbies, finding new interests, driving, supporting peers and contributing to disability organizations also carried meaning. By contrast, giving up valued activities and being unable to reciprocate support could diminish quality of life. The findings therefore connect participation with more than the amount of activity available: control over choices, perceived usefulness and the ability to engage in activities that matter personally were central features of the accounts.

Psychological adaptation emerged as another major theme, but the interviews did not portray it as complete or uniform. Some participants described growing self-awareness, greater acceptance of their abilities, new values, increased self-esteem and personal growth after injury. The spinal cord injury was sometimes described as a turning point that had forced earlier maturity or a deeper appreciation of everyday life. Others continued to feel sadness about lost functions and opportunities. Adaptation also involved developing ways to manage recurring challenges within the limits of current abilities. The adjusted statistical model could not provide an independent estimate for time since injury because its parameters were identified as redundant during analysis, so the qualitative evidence should not be interpreted as proof that quality of life necessarily rises as years since injury increase.

The social and physical environment was described as capable of either enabling or constraining life after spinal cord injury. Family members and close friends were the most important source of practical and emotional support, and peer support offered understanding from people with comparable experiences. Accessible housing, assistive devices and sufficient personal assistance could make daily activities easier, although directing assistants sometimes created an additional burden. Participants also emphasized adequate finances, meaningful relationships, work and opportunities to contribute to society. Finnish winter conditions had a particularly visible effect: cold and snow made movement with assistive devices harder, increased stiffness and reduced time spent outdoors. Although this seasonal influence is specific to a northern setting, the broader role of environmental accessibility and social resources may extend beyond Finland.

Problems with health and social services also reduced quality of life. Participants described burdensome processes, inadequate services and healthcare professionals who appeared insufficiently aware of spinal cord injury or its secondary complications. These experiences could affect practical decisions and leave people feeling that their symptoms had not been heard. At the same time, professional assistance and well-offered support could be highly valuable. The results therefore point to the importance of service provision and the way services are experienced in daily life. The study does not test any particular intervention, so it cannot establish that changing a particular service would improve quality of life.

The results carry important limitations. The FinSCI survey had a response rate of 49.9%, with 884 responses from 1,772 eligible people, and the researchers said the sample was not fully representative of everyone with spinal cord injury in Finland. Younger adults were also underrepresented among interviewees, partly because ten people declined the invitation, five of them under 30, making the qualitative sample older than intended. The survey measured general quality of life with a single item, a narrow instrument for a multidimensional and context-dependent concept, and the data were cross-sectional. The study therefore identifies associations and lived experiences rather than causal or long-term effects. Even with those constraints, its combination of population-level survey data and detailed interviews offers a multidimensional account of life after spinal cord injury, highlighting the linked roles of health, autonomy, relationships, psychological resources and the surrounding environment in how people evaluate the quality of their lives.

Subject of Research: Quality of life among people with spinal cord injury in Finland

Article Title: The quality of life experienced by persons with spinal cord injury in Finland – a mixed methods study

Article References: Eskola, K., Tallqvist, S., Zechner, M., Arokoski, J., Koskinen, E., Rajavaara, M., & Hiekkala, S. (2026). The quality of life experienced by persons with spinal cord injury in Finland – a mixed methods study. Frontiers in Rehabilitation Sciences, 7, Article 1829111. https://doi.org/10.3389/fresc.2026.1829111

Image Credits: AI Generated

DOI: 10.3389/fresc.2026.1829111

Keywords: spinal cord injury, quality of life, mixed methods, rehabilitation, social support, autonomy, psychosocial adaptation, participation, secondary health conditions, Finland, quality, life