Effects of hybrid cycling versus handcycling on wheelchair-specific fitness and physical activity in people with long-term spinal cord injury: a 16-week randomized controlled trial

Study design:This is an open randomized controlled trial.Objective:The objective of this study was to investigate the effects of a 16-week hybrid cycle versus handcycle exercise program on fitness and physical activity in inactive people with long-term spinal cord injury (SCI).Setting:The study was conducted in two rehabilitation centers with a specialized SCI unit.Methods:Twenty individuals (SCI≥8 years) were randomly assigned to a hybrid cycle (voluntary arm exercise combined with functional electrical stimulation (FES)-induced leg exercise) or a handcycle group. During 16 weeks, both groups trained twice a week for 30 min at 65-75% heart rate reserve. Outcome measures obtained before, during and after the program were fitness (peak power output, peak oxygen consumption), submaximal VO 2 and heart rate (HR), resting HR, wheelchair skill performance time score) and physical activity (distance travelled in wheelchair and Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) score). Changes were examined using a two-factor mixed-measures analysis of variance.Results:For all fitness parameters, except for submaximal VO 2, no interaction effects were found. The hybrid cycle group showed a decrease in VO 2 over time in contrast to the handcycle group (P=0.045). An overall reduction in HR rest (5±2 b.p.m.; P=0.03) and overall increase in PASIPD score (6.5±2.1; P=0.002) were found after 16 weeks of training. No overall training effects were found for the other fitness and activity outcome measures.Conclusion:In the current study, hybrid cycling and handcycling showed similar effects on fitness and physical activity, indicating that there seem to be no additional benefits of the FES-induced leg exercise over handcycle training alone

Impact of health problems secondary to SCI one and five years after first inpatient rehabilitation

Study design: This is a multicenter prospective cohort study. Objectives: The objective of this study was to describe and compare the impact of health problems secondary to spinal cord injury (SCI) on functioning at home and on social activities at 1 and 5 years after discharge from first inpatient rehabilitation. Setting: The study was conducted in a Dutch community. Methods: Participants with SCI who use a wheelchair for everyday mobility (N=110) completed a self-report questionnaire as part of a larger cohort study including four items on extra time needed (body care, bladder and bowel regulation, 'organization' and transportation) and impact of 10 health problems on functioning at home and on social activities. The 10 health problems include secondary health conditions (bladder regulation, bowel regulation, decubitus, pain, spasticity, gain in body weight and edema), psychosocial problems (sexuality, having difficulty with being dependent on help from others) and handicap management. Results: Median extra time needed for self-management and transportation was not significantly higher 1 year after discharge (16 (IQR 13.5) h per week) compared with 5 years after discharge (13 (IQR 17) h per week) (P=0.925). Participants reported slightly less impact, comparing the severity sum-score (range 10-50) of the 10 health problems on functioning at home and in social activities, 5 years post discharge (20 and 17, respectively) than 1 year post discharge (21 and 18, respectively; P Conclusions: The impact of health problems after SCI is considerable and hardly diminishes over time. These results emphasize the need for structured long-term care for people with SCI

Mental health and life satisfaction of individuals with spinal cord injury and their partners 5 years after discharge from first inpatient rehabilitation

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To describe and compare mental health and life satisfaction between individuals with spinal cord injury (SCI) and their partners 5 years after discharge from first inpatient rehabilitation; and to examine if injury severity moderates the association between individuals' with SCI and their partners' mental health and life satisfaction. SETTING: Dutch community. METHODS: Sixty-five individuals with SCI and their partners completed a self-report questionnaire. Main outcome measures were the mental health subscale of the Short-Form Health Survey and the Life Satisfaction Questionnaire. RESULTS: Levels of mental health and life satisfaction of individuals with SCI and partners were similar, with median scores of 76 and 4.8 versus 76 and 4.6, respectively. Moderate to strong correlations between individuals with SCI and their partners were found for the mental health (rS = 0.35) and life satisfaction scores (rS = 0.51). These associations were generally stronger in the subgroup of individuals with less severe SCI. Associations between scores on separate life domains ranged from negligible (0.05) to moderate (0.53). Individuals with SCI and their partners were least satisfied with their 'sexual life'. Compared with their partners, individuals with SCI were significantly more satisfied in the domains 'leisure situation', 'partnership relation' and 'family life', and less satisfied in 'self-care ability'. CONCLUSIONS: This study showed similarities but also differences in mental health and life satisfaction between individuals with SCI and their partners. In clinical practice, attention on mental health and life satisfaction should, therefore, focus on different domains for individuals with SCI and partners