Spinal cord injury (SCI) significantly impacts quality of life, necessitating effective rehabilitation. Activity-based therapy (ABT), a neurorestorative approach emphasizing intensive, task-specific movement practice, shows promise in improving outcomes. While SCI-specialized centers utilize ABT, its implementation in non-specialized centers remains unclear. This study aimed to explore the knowledge, perceptions, and implementation of ABT among physical and occupational therapists working in non-SCI-specialized centers in Canada, addressing the significant population of Canadians with SCI who may lack access to ABT due to location or other factors. The study's importance lies in enhancing understanding of the barriers to ABT delivery and informing strategies to improve access and quality of care for individuals with SCI in various settings, especially considering that 18% of the Canadian population resides in rural areas with limited access to specialized services.

The literature highlights the shift in neurorehabilitation towards restorative approaches like ABT, emphasizing task-specific, repetitive, and intensive neuromuscular activation. ABT's benefits include neurological improvements and reduced risk of secondary conditions. Studies have demonstrated ABT's effectiveness in improving mobility, neurological status, and quality of life in SCI patients. However, the existing literature focuses mainly on ABT implementation in specialized centers, neglecting the experiences of therapists in non-specialized settings, particularly in rural areas. The need to address this gap is crucial for improving accessibility and equity of care for Canadians with SCI.

This study employed an interpretive descriptive design. Seven therapists (four physical therapists and three occupational therapists) from diverse settings (acute care, inpatient/outpatient rehabilitation, long-term care, rural outpatient clinic) in Ontario and Alberta, Canada, participated. Participants were recruited through snowball sampling and met the inclusion criteria of working in a non-SCI-specialized center and having treated at least one SCI patient in the past 18 months. Semi-structured interviews, guided by the Theoretical Domains Framework (TDF), explored therapists' experiences, understanding of ABT, and implementation challenges. Interviews were audio-recorded, transcribed verbatim, and analyzed using interpretive description. Two researchers independently coded the data, developing a codebook through iterative analysis and member checking. NVivo software facilitated data management.

Three major themes emerged: (1) Available knowledge, resources, and therapy time in non-SCI-specialized centers challenge ABT implementation; (2) How current therapy practices in non-SCI-specialized centers align with ABT; and (3) Desire for ABT knowledge. Theme 1 revealed knowledge gaps about SCI and ABT, lack of access to specialized equipment and community resources, and limited therapy time due to high caseloads. Therapists often unconsciously incorporated some ABT principles into their practice. Theme 2 indicated that while therapists focused on functional independence, the intensity of their interventions did not always align with ABT principles. Theme 3 highlighted therapists’ strong interest in learning more about ABT through accessible, tailored educational resources, such as online modules and virtual learning tailored to their specific settings.

The findings underscore the limited knowledge and implementation of ABT in non-SCI-specialized centers. While therapists may unknowingly incorporate some ABT elements, systemic barriers hinder widespread adoption. The identified knowledge gaps, resource limitations, and time constraints highlight the need for targeted interventions. The study supports the need for increased access to ABT, improved communication between specialized and non-specialized centers, and the exploration of telehealth to overcome geographical barriers. The increasing prevalence of non-traumatic SCI (NT-SCI) further emphasizes the importance of providing appropriate rehabilitation in non-specialized settings.

This study revealed significant limitations in ABT knowledge and implementation within non-SCI-specialized centers. Therapists expressed a strong desire for accessible, tailored training. Future research should focus on developing and evaluating targeted educational programs and implementation strategies to improve ABT access and optimize outcomes for individuals with SCI in diverse healthcare settings. Further research comparing perspectives among stakeholders involved in rehabilitation and funding may help to identify further barriers and facilitators.

The study's limitations include the use of phone interviews, which may have limited the capture of non-verbal cues, and the representation of only two Canadian provinces. The sample size, while appropriate for a qualitative study, limits the generalizability of the findings to the broader Canadian context.