Original Article Benefits and challenges of providing transitional rehabilitation services to people with spinal cord injury from regional, rural and remote locations Susan Booth and Melissa Kendall Transitional Rehabilitation Program, Princess Alexandra Hospital, Brisbane, Queensland, Australia Abstract Objective: To identify the factors influencing participa- tion and outline the benefits and challenges of providing transitional rehabilitation for people with spinal cord injury (SCI) from rural and regional locations. Design: Grounded Theory analysis of service records and policy documents. Setting: One transitional rehabilitation service for people with SCI. Participants: Service records of 40 individuals with SCI from non-metropolitan locations who participated in transitional rehabilitation and 29 individuals with SCI who declined transitional rehabilitation over a two-year period. Interventions: Home-based transitional rehabilitation programs offered by a multidisciplinary team including physiotherapy, occupational therapy, nursing and social work. Measures: Participation was measured using the per- centage of people from non-metropolitan locations who decline transitional rehabilitation. The benefits and challenges of transitional rehabilitation were identified using open, axial and selective coding of service records. Results: People with SCI from non-metropolitan areas were underrepresented among transitional rehabilita- tion participants, with 69% of those declining transi- tional rehabilitation coming from regional or rural areas. The study identified five functions of transitional rehabilitation that presented both benefits and challenges of this model in assisting people from non-metropolitan locations. These included: (1) the identification, education, coordination and funding of local care providers; (2) family involvement in rehabili- tation; (3) contact with social and community supports; (4) specialist support to problem-solve discharge needs; and (5) skill acquisition and transfer in a community environment. Conclusions: The transitional rehabilitation model offers many advantages over traditional hospital-based rehabilitation but still faces challenges in offering an equitable model for people with SCI from non- metropolitan locations. KEY WORDS: community-based service delivery, model of service delivery, rehabilitation, rural/remote service, service evaluation. Introduction In Queensland, approximately 90 individuals sustain a spinal cord injury (SCI) each year. 1 For many people, this injury results in permanent disability and the need for ongoing assistance with daily living activities, equip- ment, accommodation, community access, financial management and social participation. 2,3 Based on injury statistics compiled since 2000, more than 40% of people with new SCI in Queensland are discharged to destina- tions located outside of the Brisbane metropolitan area, Gold Coast or Sunshine Coast. 1 Under traditional models of rehabilitation in Austra- lia, an individual who sustains a SCI is admitted to an acute care facility in a major metropolitan city, proceeds to receive inpatient rehabilitation in a major metropoli- tan hospital or rehabilitation facility, and is then dis- charged home, frequently to remote, rural or regional locations without access to specialist services. The pro- vision of specialist rehabilitation services for SCI within metropolitan locations has long presented difficulties for people from non-metropolitan locations, their families and the local service providers charged with supporting them in the community. The coordination of complex discharge planning is difficult to achieve for inpatient rehabilitation providers who lack knowledge of how people function in the community and the availability of local service provid- ers. Transitional rehabilitation (TR) is a relatively new Correspondence: Melissa Kendall, Transitional Rehabilitation Program, PO Box 6053, Buranda, Queensland, 4102, Australia. Email: melissa_kendall@health.qld.gov.au Accepted for publication 23 November 2006. Aust. J. Rural Health (2007) 15, 172–178 © 2007 The Authors Journal Compilation © 2007 National Rural Health Alliance Inc. doi: 10.1111/j.1440-1584.2007.00880.x