Voices from the Field: Cognitive Debriefing Interviews on the Corticospinal Activation Protocol with Patients and Clinicians

Abstract

Background: The development of complex rehabilitation interventions benefits from early qualitative input from both clinicians and individuals with SCI to ensure clinical relevance, feasibility, and patient-centeredness. This study reports the cognitive debriefing phase conducted during pre-formulation of the Corticospinal Activation Protocol (CAP), a multi-domain intervention for individuals with incomplete spinal cord injury (SCI). Objective: To explore clinician and patient perspectives on current SCI rehabilitation practice, unmet needs, and design preferences, in order to inform the pre-formulation of CAP. Methods: Face-to-face, semi-structured cognitive debriefing interviews were conducted with 5 clinicians (≥ 5 years' SCI rehabilitation experience) and 5 individuals with incomplete SCI, using two parallel purpose-built interview guides, following purposive sampling with pre-specified eligibility criteria (Section 2.3). Data were analyzed using reflexive thematic analysis (Braun and Clarke, 2006). Findings: Clinicians emphasized the need for standardization, structured training programmes, adequate manpower, multidisciplinary care models, regulatory oversight of practice, and dedicated fellowship pathways. Individuals with SCI described architectural and financial barriers, exposure to unqualified practitioners, poor referral pathways from neurosurgeons, a preference for exercise-based over electrotherapy-based interventions, gaps in bowel/ bladder training, limited awareness of sexual health prognosis, and a desire for more engaging, less monotonous therapy design. Both groups independently raised concerns about unregulated practice and poor referral pathways. Conclusion: Cognitive debriefing interviews surfaced practical, safety, and engagement-related considerations that directly informed the pre-formulation design of CAP, complementing later formal expert consensus (Modified Delphi) validation.