Autonomic function and spinal cord injury: Exploring healthcare provider perspectives on bowel care & reimagining autonomic dysreflexia

Spinal cord injury (SCI) can lead to comorbidities that reduce quality of life (QoL), including neurogenic bowel dysfunction and dangerous spikes in blood pressure called autonomic dysreflexia (AD). This thesis aims to contribute to improving the QoL of individuals with SCI. Most individuals with SCI are dissatisfied with their bowel care, but despite dissatisfaction, have not changed it. Chapter 2 presents health care provider barriers and facilitators to conversations about changing bowel care. Several key themes were identified that help or hinder optimising bowel care (knowledge, experience, education and responsibility are needed to have conversations; time and teamwork are valuable yet limited; interpersonal dynamics are present and impactful; beliefs and intentions shape decisions to have conversations). Chapter 3 offers an editorial on the definition of AD; it presents the current definition and considers options for optimisation of AD criteria. Collectively, these chapters contribute to understanding of QoL-limiting problems after SCI.