Low-intensity wheelchair training in inactive people with long-term spinal cord injury: A randomized controlled trial on fitness, wheelchair skill performance and physical activity levels

Objective: To investigate the effects of low-intensity wheelchair training on wheelchair-specific fitness, wheelchair skill performance and physical activity levels in inactive people with long-term spinal cord injury. Design: Randomized controlled trial. Participants: Inactive manual wheelchair users with spinal cord injury for at least 10 years (n = 29), allocated to exercise (n = 14) or no exercise. Methods: The 16-week training consisted of wheelchair treadmill-propulsion at 30-40% heart rate reserve or equivalent in terms of rate of perceived exertion, twice a week, for 30 min per session. Wheelchair-specific fitness was determined as the highest 5-s power output over 15-m overground wheelchair sprinting (P5-15m), isometric push-force, submaximal fitness and peak aerobic work capacity. Skill was determined as performance time, ability and strain scores over a wheelchair circuit. Activity was determined using a questionnaire and an odometer. Results: Significant training effects appeared only in P5-15m (exercise vs control: mean +2.0 W vs -0.7 W, p = 0.017, ru=0.65). Conclusion: The low-intensity wheelchair training appeared insufficient for substantial effects in the sample of inactive people with long-term spinal cord injury, presumably in part owing to a too-low exercise frequency. Effective yet feasible and sustainable training, as well as other physical activity programmes remain to be developed for inactive people with long-term spinal cord injury. Key words: activities of daily living; paraplegia; physical activity; physical fitness; spinal cord injuries; tetraplegia; rehabilitation; wheelchairs

Trajectories in the course of body mass index after spinal cord injury

OBJECTIVE: To identify different trajectories of the course of body mass index (BMI) after spinal cord injury (SCI) and to study whether other cardiovascular risk factors (blood pressure, lipid profile) follow the same trajectories. DESIGN: Multicenter prospective cohort study with measurements at the start of active rehabilitation, after 3 months, at discharge, and 1 and 5 years after discharge. SETTING: Rehabilitation centers. PARTICIPANTS: Persons with a recent SCI (N=204). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: BMI trajectories. RESULTS: Three BMI trajectories were identified: (1) a favorable stable BMI during and after rehabilitation (± 22-23 kg/m(2)) (54%); (2) a higher but stable BMI during inpatient rehabilitation (± 24 kg/m(2)) and an increase after discharge (up to 29 kg/m(2)) (38%); and (3) an increase in BMI during inpatient rehabilitation (from ± 23 up to 28 kg/m(2)) and leveling off after discharge (8%). Profile analyses showed that an unfavorable change in BMI was not accompanied by clear unfavorable changes in blood pressure or lipid levels. CONCLUSIONS: BMI in people with SCI follows distinct trajectories. Monitoring body mass, food intake, and daily physical activity during and especially after inpatient SCI rehabilitation is important to prevent obesity and related cardiovascular risk factors

Functional independence of persons with long-standing motor complete spinal cord injury in the Netherlands

Context/Objective: Since life expectancy of persons with spinal cord injury (SCI) has improved, it is relevant to know whether this group is able to maintain functional abilities many years after onset of SCI. Objectives of this study were (1) to examine associations between time since injury (TSI) and functional independence in persons with long-standing SCI and (2) to explore associations between functional independence and level of injury, comorbidities, mental health, waist circumference and secondary health conditions (SHCs). Design: TSI-stratified cross-sectional study. Strata were 10–19, 20–29 and 30+ years. Setting: Community. Participants: 226 persons with long-standing SCI. Inclusion criteria: motor complete SCI; age at injury 18–35 years; TSI ≥ 10 years; current age 28–65 years; wheelchair dependency. Interventions: Not applicable. Outcome measures: The Spinal Cord Independence Measure III (SCIM) was administered by a trained research assistant. Level of injury, comorbidities, mental health, waist circumference and SHCs were assessed by a rehabilitation physician. Results: Mean TSI was 23.6 (SD 9.1) years. No significant differences in SCIM scores were found between TSI strata. SCIM scores were lower for persons with tetraplegia, autonomic dysreflexia, hypotension, more than four SHCs and a high waist circumference. In linear regression analyses, TSI nor age was associated with the SCIM total score. Only level of injury (β = –0.7; P <.001) and waist circumference (β = –0.1; P =.042) were independent determinants (explained variance 55%). Conclusion: We found no association between TSI and functional independence in persons with long-standing motor complete SCI. This study confirms the possible effect of overweight on functional independence

Bladder-emptying methods, neurogenic lower urinary tract dysfunction and impact on quality of life in people with long-term spinal cord injury

Objectives: To describe bladder-emptying methods used by people with long-term spinal cord injury (SCI) and to determine usage differences in relation to time since injury, sex, lesion level and completeness of lesion. Furthermore, to evaluate the relationship between bladder-emptying methods and the impact of neurogenic lower urinary tract dysfunction (NLUTD) on quality of life (QoL). Design: Cross-sectional multicenter study. Setting: Dutch community. Participants: Persons dependent on wheelchairs (N = 282) with traumatic or non-traumatic SCI for = 10 years and age at injury of 18-35 years. Interventions: Not applicable. Outcome measures: The International Lower Urinary Tract Function Basic SCI Data Set and the Short-Form Qualiveen (SF-Qualiveen). Results: Median time since injury was 22.0 years (IQR: 16.8-30.3). Clean intermittent catheterization (CIC) was most commonly used (42.6%). Longer time since injury was associated with fewer continent urinary diversions and more transurethral catheter use. Transurethral catheter use and continent urinary diversions were more prevalent among women. Participants with tetraplegia were more likely to use reflex voiding or a suprapubic catheter, and participants with paraplegia were more likely to use CIC. Transurethral catheter users reported the highest impact of NLUTD on quality of life (SF-Qualiveen score: 1.9; SD= 0.8). Participants with a continent urinary diversion reported the lowest impact (SF-Qualiveen score: 0.9; SD = 0.6). Higher age and indwelling catheter use versus CIC were associated with a higher impact of NLUTD on QoL. Conclusions: CIC is the most common bladder-emptying method in Dutch people with long-term SCI. Clinicians should be aware of the impact of NLUTD on QoL, especially for those using an indwelling catheter

Progress of the Dutch Spinal Cord Injury Database:Completeness of Database and Profile of Patients Admitted for Inpatient Rehabilitation in 2015

Background: In the Dutch International Spinal Cord Injury (SCI) Data Sets project, we translated all International SCI Data Sets available in 2012 and created a Dutch SCI Database (NDD). Objective: To describe the number of included patients and completeness of the NDD, and to use the NDD to provide a profile of people with traumatic SCI (T-SCI) and non-traumatic SCI (NT-SCI) in the Netherlands. Methods: The NDD includes patients admitted for their first inpatient rehabilitation after onset of SCI to 1 of the 8 rehabilitation centers with a specialty in SCI rehabilitation in the Netherlands. Data of patients admitted in 2015 were analyzed. Results: Data for 424 patients were available at admission; for 310 of these patients (73.1%), discharge data were available. No significant differences were found between patients with and without data at discharge. Data were nearly complete (>90%) for lower urinary tract, bowel, pain, and skin. Data on sexual function has the lowest completion rate. Complete neurological and functional data were available for 41.7% and 38%, respectively. Most patients were male (63.4%), had NT-SCI (65.5%), and had incomplete SCI (58.4% D). Patients with T-SCI differed from patients with NT-SCI on most characteristics, and they stayed considerably longer in the rehabilitation center (112 days vs 65 days, p < .001). Place of discharge was not different between both groups. Conclusion: With the NDD, we collect important data on the majority of Dutch SCI patients, although much work needs to be done to improve the completeness of the data collection

Return to work five years after spinal cord injury inpatient rehabilitation: is it related to wheelchair capacity at discharge?

Objective: To describe the proportion of people with spinal cord injury who returned to work 5 years after discharge from inpatient rehabilitation, and to investigate whether return to work is related to wheelchair capacity at discharge from inpatient rehabilitation. Design: Multi-centre prospective cohort study. Subjects: A total of 103 participants with acute spinal cord injury at 8 Dutch rehabilitation centres, specialized in the rehabilitation of spinal cord injury. All participants were in paid employment before injury. Methods: Main outcome measure was return to work for at least 1 h per week. The independent variables of wheelchair capacity were peak oxygen uptake (VO2peak), peak aerobic power output (POpeak), and wheelchair skill scores (ability, performance time, and physical strain). Possible confounders were age, gender, lesion level and lesion completeness, and educational level. Results: The proportion of participants who returned to work was 44.7%. After correction for the confounders, POpeak (p=0.028), ability score (p=0.022), performance time (p=0.019) and physical strain score (p=0.038) were significantly associated with return to work. VO2peak was not significantly associated with return to work. Conclusion: More than 40% of the participants were able to return to paid work within :5 years after discharge from inpatient rehabilitation. Return to work was related to wheelchair capacity at discharge. It is recommended to train wheelchair capacity during rehabilitation in the context of return to work, since the association with return to work is another benefit of the training of wheelchair capacity in addition to the improvement of mobility and functional independency

Wheelchair-specific fitness of persons with a long-term spinal cord injury: Cross-sectional study on effects of time since injury and physical activity level

Purpose: To study the impact of time since injury (TSI) and physical activity (PA) on fitness of persons with spinal cord injury (SCI). Method: Cross-sectional study. Persons with SCI (N = 158) in three TSI strata: 10-19, 20-29 and ≥30 years after SCI and divided in an active and inactive group. Fitness [peak power output (POpeak) and peak oxygen uptake (VO2peak)] was assessed. Results: In persons with tetraplegia, no significant relationship was found between TSI and fitness after controlling for confounders, while a higher activity level was related to a higher POpeak in this group. Active people with tetraplegia also showed less decline in POpeak with an increase in TSI compared to inactive people. In persons with paraplegia, after controlling for confounders, it was shown that TSI had a negative effect on POpeak, while PA was not significantly associated with fitness in people with paraplegia. Conclusions: In people with paraplegia, fitness was significantly lower in those with a longer TSI. Persons with a long TSI might need more attention to remain fit and PA might be an important element in that respect as shown by the results of the group with a tetraplegia.Implications for RehabilitationWheelchair-specific fitness seems to diminish over time after paraplegia.An active lifestyle is related to wheelchair-specific fitness in persons with tetraplegia.Prevention of long-term deconditioning is very important