Physical activity in wheelchair-using youth with spina bifida: an observational study

Background: Even though typically developing youth are already at risk for physical inactivity, youth with spina bifida may be even at higher risk as a consequence of their reduced mobility. No objective data is available for youth with spina bifida who use a manual wheelchair, so the seriousness of the problem is unknown. The purpose of this observational study was to quantify physical activity in wheelchair-using youth with spina bifida and evaluate the intensity of activities. Methods: Fifty-three children and adolescents (5–19 years) with spina bifida who use a manual wheelchair for daily life, long distances or sports were included. To assess time spent in several types of activities VitaMove data of 34 participants were used and were presented as time spent sedentary and time spent physically active. This was compared to reference data of typically developing youth. To assess time spent in several intensities Actiheart data of 36 participants were used. The intensities were categorized according to the American College of Sports Medicine, ranging from very light intensity to near to maximal intensity. Data of 25 participants were used to combine type of activity and intensity. Results: Children and adolescents with spina bifida who use a manual wheelchair were more sedentary (94.3% versus 78.0% per 24 h, p < 0.000) and less physically active (5.0% versus 12.2% per 24 h, p < 0.000) compared to typically developing peers. Physical activity during weekend days was worse compared to school days; 19% met the Guidelines of Physical Activity during school days and 8% during weekend days. The intensities per activity varied extensively between participants. Conclusions: Children and adolescents with spina bifida who use a manual wheelchair are less physically active and more sedentary than typically developing youth. The physical activity levels on school days seem to be more favorable than the physical activity levels on a weekend day. The low levels of physical activity need our attention in pediatric rehabilitation practice. The different intensities during activities indicate the importance of individually tailored assessments and interventions

Physical fitness and physical behavior in (wheelchair-using) youth with spina bifida

Associations between low physical fitness, unfavorable physical behavior and higher cardiovascular and overall mortality are well known. Children with a physical disability like spina bifida (SB) are at high risk of decreased levels of physical fitness and unfavorable physical behavior. They seem to be prone to a vicious circle of decreased mobility and functional impairment, resulting in an inactive lifestyle, obesity, reduced health related quality of life, lower levels of physical fitness and decreased participation. Even though optimizing physical fitness in youth with disabilities are important goals in rehabilitation, there are no valid and reliable tests available to measure physical fitness in wheelchair-using youth with SB. Furthermore, evidence about physical behavior in this population is lacking. Although we expect that the majority does not comply to physical activity (PA) guidelines, we do not have objective evidence to truly understand the seriousness of physical inactivity problem in this population. The aims of this thesis were to develop valid and reliable physical fitness tests for wheelchair-using youth with SB, to objectively measure physical behavior, analyze facilitators and barriers for participation in PA and evaluate effectiveness of PA interventions. We performed three clinimetric studies. First we found that the Graded Wheelchair Propulsion Test showed significantly higher heart rate peak and higher VO2peak compared to the Graded Armcranking Exercise Test with a good reliability. Therefore, we advised to use wheelchair propulsion for measuring VO2peak in wheelchair-using youth with SB. Secondly, the Shuttle Ride Test (SRiT), a field-based propulsion test, was found to be highly valid and reliable to measure aerobic fitness. In the third study we found that the Muscle Power Sprint Test, the 10x5 Meter Sprint Test and the slalom test were highly valid and reliable for measuring skill-related fitness. We performed two observational studies using objective accelerometers to assess both types of physical activities and intensity. Only 19% (schooldays) – 8% (weekend days) of wheelchair-using youth with SB met the PA guidelines of the American College of Sports Medicine. An older age and the inability to walk influenced physical behavior negatively, gender and VO2peak were not associated with physical behavior. Interestingly, a large percentage of the variance in physical behavior remained unexplained, implicating that there are other important factors. We additionally performed qualitative research and systematic reviews and found that a wide variety of factors were associated with PA in both children with SB and in children with physical disabilities. Overall, competence in skills, sufficient fitness and self-efficacy were important personal factors. Environmental factors associated with PA included contact with and support from others, the use of assistive devices for mobility and care, adequate information regarding sports possibilities and availability and accessibility of playgrounds and sports facilities. Finally, we found that there was no effect of training on PA in children with physical disabilities, conflicting evidence for the effect of interventions with a behavioral component on the short term and no effect on the long term. More research using innovative approaches is needed to develop and investigate interventions for improving physical behavior

Wheelchair mobility confidence scale for Dutch youth using a manual wheelchair.

Purpose The objective of this study was to develop a questionnaire to assess confidence in wheelchair mobility in Dutch youth (WheelCon-Mobility Dutch Youth). Methods (1) A forward–backward translation process was used to translate the original WheelCon-M from English to Dutch. (2) Items related to wheelchair mobility in Dutch youth were selected and adapted based on focus groups with youth, parents and health care professionals to create the WheelCon-Mobility Dutch Youth. (3) The WheelCon-Mobility Dutch Youth and the Utrecht Pediatric Wheelchair Mobility Skills Test 2.0 (UP-WMST 2.0) were administered to 62 participants to evaluate internal consistency and construct validity. Results Translation and cultural adaptation led to general adaptations in instructions, sentence structure and response scale. At the item level, 24 items were included with (n ¼ 17) and without (n ¼ 7) adaptation, 10 items were deleted and 7 new items were included. The WheelCon-Mobility Dutch Youth had an excellent Cronbach’s alpha of 0.924 and a significant correlation (r ¼ 0.44, p < .001) with the UP-WMST 2.0. Conclusions This study resulted in the adaptation of the WheelCon-M into the WheelCon-Mobility for Dutch youth using a manual wheelchair. Our study suggests there is evidence supporting the internal consistency and construct validity of the WheelCon-Mobility Dutch Youth

Factors associated with physical activity in children and adolescents with a physical disability: a systematic review.

Aim: The aim of this review was to summarize the important factors associated with participation in physical activity in children and adolescents with physical disabilities. Method: A systematic mixed-studies review was conducted using the databases Academic Search Elite, CINAHL, The Cochrane Library, EMBASE, PEDro, PsycINFO, PubMed, and SPORTDiscus, searching for studies conducted from January 2000 to May 2013. The studies were identified by two independent researchers following predetermined inclusion and exclusion criteria. The methodological quality was determined using the McMaster University critical review forms for qualitative or quantitative research and was numerically rated according to the criteria developed by Imms. Results: The initial electronic search yielded 10 161 articles, of which six were qualitative and 12 were quantitative studies. These studies showed that a diverse range of positive and negative factors were associated with participation in physical activity, such as self-efficacy, physical fitness, increasing age, and the availability of equipment and local facilities. Interpretation: Future intervention studies could use these results, within the context of an individual child and his or her environment, as the basis for increasing physical activity levels, starting in early childhood and continuing throughout adolescence and into adulthood. An increased awareness of and focus on providing appropriate equipment and adapted sports in the child's own environment by policy makers might increase physical activity levels. (aut. ref.