# Territorial Continuity of Care for Patients with Spinal Cord Injury: A Focus Group Study
## 1 Introduction  
Spinal cord injury (SCI) is a complex neurological condition, characterized by significant impairment for a wide range of bodily systems and functions [1]. SCI can occur following traumatic events, such as road accidents, accidental falls, gunshot wounds and sports-related injuries, or non-traumatic events, including tumors, infections, degenerative diseases or congenital causes [2]. The injury typically evolves as follows: a spinal shock acute phase, with a duration of 3-4 days to 6-8 weeks; a subacute phase (2 months to 6 months); and a chronic phase that occurs 6 months after the injury. Subsequently, clinical presentation stabilizes and the pathology becomes chronic [3].  
As for primary damage, SCI triggers a loss of muscle strength, sensitivity, and impairment of visceral functions [4]. Bodily symptoms impact patients' social and psychological sphere, lowering their participation, quality of life and consequently overall health [5].  
Managing chronic SCI (>6 months) presents unique and often complex challenges, with high requests for long-term multidisciplinary care [6]. During hospitalization, healthcare professionals dealing with an SCI patient usually focus on the definition of measurable therapeutic objectives within the short term, often overlooking the challenges which patients face in adapting to a new daily reality after discharge, characterized by individual needs, perplexities and problems [5; 7]. Additionally, the amount of assistance and rehabilitation services provided by hospitals or centers is often insufficient to adequately prepare patients and their families for a new life [8]. These assumptions suggest that the involvement of the entire multidisciplinary rehabilitation care team is fundamental for managing these patients, supporting recovery at the best possible level of self-efficacy, and preventing the onset of secondary complications due to chronicity [4].  
Currently, the international literature highlights that a universal model for the management of chronic SCI has not been yet developed [5]. This lack of a comprehensive model can result in inadequate support for patients after discharge. Recent studies, indeed, report challenges that patients themselves face in transferring skills from the rehabilitation setting into community life for the purpose of psychosocial reintegration.  
Recent studies [9] highlight the difficulty of people with SCI in accessing the same level of primary healthcare as able-bodied people. This insufficient response to their needs is due to multiple factors, such as inaccessible healthcare facilities, lack of appropriate equipment and inadequate training of healthcare professionals in SCI management [8].  
The present study employed a qualitative approach using Focus Group Discussion (FDG) to explore the perspectives of patients and healthcare professionals on rehabilitation and care continuity for individuals with chronic SCI. In particular, the research aimed to explore the life experiences of those directly involved in the care process, to identify the challenges and opportunities which characterize the management of chronicity [10]. This study also lays the groundwork for future quantitative research and its premise allows allocation for further investment in the field.