# New Remote Care Models in Patients with Spinal Cord Injury: A Systematic Review of the Literature
## 1 Introduction  
The World Health Organization (W.H.O.) defines spinal cord injury (SCI) as a complex medical and life condition caused by any injury to the spinal cord, the conus medullaris, and the cauda equine [1]. SCI can be either traumatic or non-traumatic, characterized by the loss or impairment of motor, sensory, or autonomic functions below the level of injury [2]. Worldwide, the incidence of traumatic SCI is 250,000-300,000 people each year, and it has been estimated that a person with SCI has 2 to 5 times higher risk of premature mortality compared to a healthy person [3]. Global estimates indicate that approximately 15.4 million people were living with SCI in 2021 [4]. Despite that motor impairment represents the most studied consequence of SCI, a great number of systems and organs are involved in thesecondary damage of this condition, respiratory impairment, bladder-sphincter control deficit, neurogenic bowel dysfunction, sexual inability, thermoregulatory dysfunctions, and cardiovascular issues, all of which are common in SCI people [5]. Given clinical complexity, a SCI exposes patients to extremely severe tertiary damages, such as pressure ulcers (PUs), urinary tract infections, sepsis, metabolic disorders with osteoporosis and increased risk of fractures, higher risk of venous thrombosis and embolism, spinal deformities, severe spasticity with enforced postures, and joint limitations. These tertiary damages are often the main long-term cause of serious and fatal complications, significantly impacting life expectancy and care burden for those who suffer a spinal compromission [6]. The psychological, familial, and social consequences of these situations are also complex, causing in most cases a severe quality of life impairment and social reintegration problems [7]. People with more severe SCI often require continuous care and support, provided largely by informal caregivers [4]. SCI, often, represents a sudden event that disrupts individuals, forcing them to reposition themselves within the community with new challenges. Due to the highly disabling nature of this condition, it represents a significant risk factor for social exclusion, poverty, and premature mortality [8]. A spinal cord injury, due to its numerous and varied complications [9], entails a significant care commitment, making it a lifelong disability condition [10], leading to a high healthcare, economic, and social burden for affected individuals and families [2]. The care pathway for an SCI patient requires multiprofessional assistance in all settings, involving nursing, rehabilitation, relational, educational, psychological, and social interventions [11], requiring a coordinated, integrated, and multidisciplinary approach to ensure a smooth transition between inpatient, outpatient, and territorial activities [1]. Prevention, early diagnosis, and treatment of secondary conditions related to SCI are essential to increase life expectancy [4]. The nurse plays a central role throughout the care pathway of an SCI patient, especially in promoting a clinical-care model that goes beyond a task-based work, instead favouring comprehensive and continuous care, in order to achieve a multidisciplinary and tailored assistance [12]. In recent years, the COVID-19 pandemic highlighted the need to introduce new technologies in the context of long-term assistance settings [13]. Technological development, and the consequent expansion of telehealth, represent a great opportunity for patients, allowing them to receive home care without continuous hospitalizations [14]. For people living in rural or medically underserved areas, access to care could be difficult or even nonexistent [15]. Financial limitations, travel and care costs [16], and weather conditions impact access to healthcare assistance [17]. Transportation to hospitals/clinics could be a barrier due to journey length and duration and discomfort [18].