Effects of community peer-led programmes for people with spinal cord injury in Sweden-the INTERnational project for the evaluation of active rehabilitation (INTER-PEER).

STUDY DESIGN: Longitudinal prospective cohort study. OBJECTIVES: To assess the effects of Active Rehabilitation (AR) training programmes for individuals with spinal cord injury (SCI) on physical independence, self-efficacy and wheelchair skills, and to identify factors that are associated with gains in these outcomes. SETTING: Eight consecutive AR programmes in Sweden. METHODS: Participants (n = 111) with traumatic or nontraumatic SCI, aged 16 years and older, were evaluated at the start (T1) and completion (T2) of the programme, and at 3-month follow-up (T3). Assessments included standardised self-reported outcome measures (T1-T2-T3) and a practical wheelchair skills test (T1-T2). RESULTS: After attending the short, intensive peer-led AR programmes, participants reported gains in physical independence, especially in dressing and washing, bowel management, bed mobility, and transfers. Wheelchair skills improved, while improvements in aspects of self-efficacy and resilience were observed only at programme completion. Gains in physical independence and self-reported wheelchair skills were present at the 3-month follow-up. With few exceptions, examined predictors did not explain the observed outcome gains. CONCLUSION: AR programmes offer an effective, low-cost opportunity to improve essential and challenging aspects of physical independence and wheelchair skills among community-dwelling individuals with SCI. Immediate gains in aspects of self-efficacy and resilience-though not sustained at follow-up-may provide an initial momentum for future behavioural change, particularly among individuals who struggle to adjust to life after SCI. These findings strongly support the inclusion of intensive, residential, community-based peer-led programmes as a key component of the rehabilitation continuum for people with SCI.