Cardiovascular capacity in individuals with cervical spinal cord injury

Background: The prevalence of cardiovascular disease in individuals with cervical spinal cord injury (SCI) is high, yet research surrounding the improvement of cardiovascular fitness in this population is lacking. Purpose: 1) To systematically review the published literature to assess the effects of exercise modality, time since injury, injury severity, and training on VO₂peak values in individuals with cervical SCI; 2) to develop an aerobic exercise program to enhance aerobic capacity in a patient undergoing primary rehabilitation from a motor-complete C5/6 SCI. Methods: Part 1. A systematic review of the literature was undertaken to identify published studies measuring VO₂peak in individuals with cervical SCI. Scatterplots were generated to illustrate the effects of exercise modality, time since injury, and injury severity on VO₂peak. Effect sizes were calculated for the response to training on VO₂peak. Part 2. Using the American College of Sports Medicine (ACSM) guidelines, an aerobic exercise program was developed for individuals with cervical SCI. Activity stations were designed to challenge aerobic capacity while minimizing muscular fatigue. The program was trialed on one subject with a C5 AIS A SCI undergoing sub-acute rehabilitation from injury. Results: The literature review identified 40 studies reporting VO₂peak in individuals with cervical SCI. Scatterplots illustrated that VO₂peak was influenced by injury severity, but not exercise modality. Effect sizes for VO₂peak ranged from 0 to 21 (using pre-training standard deviations) in response to training. The case study of an individual with a C5 AIS A SCI showed that participation in the aerobic training program facilitated increased exercise tolerance, both in terms of exercise duration and exercise intensity. Measures of cardiovascular health, taken before and after training, showed increases in peak oxygen uptake and orthostatic tolerance over the 2 month course of the program. Conclusions: The systematic review provided further evidence that VO₂peak is related to injury severity. The training studies reviewed suggest that it is possible for individuals with tetraplegia to gain cardiovascular benefits from aerobic training. The subject in our case study exhibited several signs of improved exercise tolerance over the 2 month program, indicating potential cardiovascular improvement from the exercise training.Medicine, Faculty ofGraduat

Psychometric properties of the International Society of Wheelchair Professionals' basic manual wheelchair-service-provision knowledge Test Version 1 and development of Version 2.

IntroductionValid and reliable scores from measurement tools to test competency in basic manual wheelchair-service-provision are needed to promote good practice and support capacity building. The International Society of Wheelchair Professionals' (ISWP) Basic Test Version 1 in English, launched in 2015, is the most frequently used outcome measure tool to test basic manual wheelchair-service-provision knowledge and is part of an international certification process. Despite the wide acceptance and use of the test, its psychometric properties have not yet been established. The objectives of this study were 1) to evaluate the test's psychometric properties, 2) to develop the test's Version 2, and 3) to evaluate the content validity of the new version.MethodsFor Objective 1, methods from the Classical Test Theory were used to obtain items' difficulty, item discrimination index and domains' reliability. For Objective 2, a team of experts in wheelchair service delivery and education conducted a systematic qualitative review of the questions' text and answers and updated them using evidence-based guidelines. For Objective 3, an external team reviewed the clarity, relevance and domain allocation of the developed items using a 4-point Likert scale. Descriptive statistics were used to describe and characterize the results for each objective. Item-content (I-CVI) and Scale-content (S-CVI) validity indexes were calculated to compute content validity.ResultsFor Objective 1, all domains in the test were below the threshold for acceptable internal consistency reliability; 80% of the total test pool (116 items from the total pool of 145) did not meet the thresholds for item difficulty and index of discrimination suggested in the literature. Of the items in the Test, 78% could be responded to intuitively and 66% did not distinguish between test-takers who were knowledgeable in the content area and those who were not. For Objective 2, experts found concerns such as items being grouped in the wrong domain, being repeated, not using person-first language, and using terms inconsistently. Thirty-four (23.4%) items were dropped and 111 (76.5%) were updated. In addition, 61 new items were developed. Members re-categorized the items and proposed a new classification of subdomains. For Objective 3, good agreement between subject-matter experts was found; the S-CVI calculated using the I-CVIs related to item clarity was 84% while using the I-CVIs related to item relevance was 98%. Only 7 items (4.1%) were deemed to be in the wrong domain and 4 items (2.3%) were considered irrelevant and dropped.ConclusionThe psychometric evidence in support of ISWP Basic Test Version 1 in English is suboptimal. A new set of items developed by experts in the field has shown excellent content validity. Ongoing assessments will be needed as ISWP Basic Test Version 2 is implemented and monitored

Psychometric properties of the International Society of Wheelchair Professionals’ basic manual wheelchair-service-provision knowledge Test Version 1 and development of Version 2

Introduction Valid and reliable scores from measurement tools to test competency in basic manual wheelchair-service-provision are needed to promote good practice and support capacity building. The International Society of Wheelchair Professionals’ (ISWP) Basic Test Version 1 in English, launched in 2015, is the most frequently used outcome measure tool to test basic manual wheelchair-service-provision knowledge and is part of an international certification process. Despite the wide acceptance and use of the test, its psychometric properties have not yet been established. The objectives of this study were 1) to evaluate the test’s psychometric properties, 2) to develop the test’s Version 2, and 3) to evaluate the content validity of the new version. Methods For Objective 1, methods from the Classical Test Theory were used to obtain items’ difficulty, item discrimination index and domains’ reliability. For Objective 2, a team of experts in wheelchair service delivery and education conducted a systematic qualitative review of the questions’ text and answers and updated them using evidence-based guidelines. For Objective 3, an external team reviewed the clarity, relevance and domain allocation of the developed items using a 4-point Likert scale. Descriptive statistics were used to describe and characterize the results for each objective. Item-content (I-CVI) and Scale-content (S-CVI) validity indexes were calculated to compute content validity. Results For Objective 1, all domains in the test were below the threshold for acceptable internal consistency reliability; 80% of the total test pool (116 items from the total pool of 145) did not meet the thresholds for item difficulty and index of discrimination suggested in the literature. Of the items in the Test, 78% could be responded to intuitively and 66% did not distinguish between test-takers who were knowledgeable in the content area and those who were not. For Objective 2, experts found concerns such as items being grouped in the wrong domain, being repeated, not using person-first language, and using terms inconsistently. Thirty-four (23.4%) items were dropped and 111 (76.5%) were updated. In addition, 61 new items were developed. Members re-categorized the items and proposed a new classification of subdomains. For Objective 3, good agreement between subject-matter experts was found; the S-CVI calculated using the I-CVIs related to item clarity was 84% while using the I-CVIs related to item relevance was 98%. Only 7 items (4.1%) were deemed to be in the wrong domain and 4 items (2.3%) were considered irrelevant and dropped. Conclusion The psychometric evidence in support of ISWP Basic Test Version 1 in English is suboptimal. A new set of items developed by experts in the field has shown excellent content validity. Ongoing assessments will be needed as ISWP Basic Test Version 2 is implemented and monitored