Spinal cord injury in North Macedonia with a community dwelling comparison to Norway

The overall aim of this thesis was to describe the patient’s path from a traumatic SCI (tSCI) to a community dwelling situation in North Macedonia and to compare community dwelling in North Macedonia to a similar group in Norway. Along the way, challenges conducting an epidemiological study in North Macedonia appeared, which we also found important to communicate and publish. We found that the incidence of tSCI in North Macedonia is 13 persons/million inhabitants per year (2015-16). Primary causes of injury were traffic accidents and falls. Around half were working accidents at construction sites or in agriculture. Overall in-hospital mortality rate was 32%. For those aged above 75 years, in-hospital mortality was 100%. Among the participants, around half were polytraumatized, these being more susceptible to in-hospital complications such as development of pressure injuries and infections. Rehabilitation was delayed or was not a given option for most of them. Pain and spasms were the most commonly reported health complaints in community dwelling persons with tSCI in North Macedonia, as were among Norwegian tSCI patients. Among the North Macedonians, self-treatment, including selfmedication, were reported as they were not regularly followed-up in the health-services. In contrast, Norway has a specialized and systematic rehabilitation health service for people with tSCI, which is among the best in the world. Our results show that people with tSCI have different opportunities depending on the country they live in. Home adjustments, health care organization, state support, transport and mobility possibilities are fundamentally different in North Macedonia and Norway, and for people with tSCI those are the things that can make huge differences in social inclusion, employment, and at the end – with quality of life and function. There is an urgent need to organize and offer specialized and systematic SCI rehabilitation services in North Macedonia