Development and evaluation of an activity measure for people with spinal cord injury

A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review

BACKGROUND

Accurate assessment is required to assess current and changing physical activity levels, and to evaluate the effectiveness of interventions designed to increase activity levels. This study systematically reviewed the literature to determine the extent of agreement between subjectively (self-report e.g. questionnaire, diary) and objectively (directly measured; e.g. accelerometry, doubly labeled water) assessed physical activity in adults.

METHODS

Eight electronic databases were searched to identify observational and experimental studies of adult populations. Searching identified 4,463 potential articles. Initial screening found that 293 examined the relationship between self-reported and directly measured physical activity and met the eligibility criteria. Data abstraction was completed for 187 articles, which described comparable data and/or comparisons, while 76 articles lacked comparable data or comparisons, and a further 30 did not meet the review's eligibility requirements. A risk of bias assessment was conducted for all articles from which data was abstracted.

RESULTS

Correlations between self-report and direct measures were generally low-to-moderate and ranged from -0.71 to 0.96. No clear pattern emerged for the mean differences between self-report and direct measures of physical activity. Trends differed by measure of physical activity employed, level of physical activity measured, and the gender of participants. Results of the risk of bias assessment indicated that 38% of the studies had lower quality scores.

CONCLUSION

The findings suggest that the measurement method may have a significant impact on the observed levels of physical activity. Self-report measures of physical activity were both higher and lower than directly measured levels of physical activity, which poses a problem for both reliance on self-report measures and for attempts to correct for self-report - direct measure differences. This review reveals the need for valid, accurate and reliable measures of physical activity in evaluating current and changing physical activity levels, physical activity interventions, and the relationships between physical activity and health outcomes.

Physical activity is related to lower levels of pain, fatigue and depression in individuals with spinal-cord injury: a correlational study

STUDY DESIGN

This was a prospective cross-sectional study for people with chronic spinal cord injury (SCI).

OBJECTIVES

To (1) evaluate the intensity level and nature of physical activity in community-dwelling individuals living with SCI, and (2) explore the relation between descriptive individual variables (for example, lesion level), secondary complications and participation in physical activity.

SETTING

Urban community setting.

METHODS

A total of 49 subjects with SCI who used a manual wheelchair for primary mode of mobility (mean years since injury, 11.8; mean age, 43.7 years; 67% paraplegia) completed the physical activity recall assessment for people with SCI (PARA-SCI).

RESULTS

Approximately 50% of reported physical activity among individuals with SCI is due to activities of daily living. The amount of physical activity was not related to lesion level, age, body mass index or waistline size. Greater heavy-intensity activity was related to lower levels of pain and fatigue and higher levels of self-efficacy, whereas higher amounts of mild-intensity activity and total activity were related to less depressive symptoms.

CONCLUSIONS

Activities of daily living are a large component for physical activity among individuals with SCI. It appears that greater physical activity is associated with less secondary complications (pain, fatigue and depression) in individuals with SCI.

Clinical assessment and management of obesity in individuals with spinal cord injury: a review

BACKGROUND

Diagnosing and managing obesity in individuals with spinal cord injury (SCI) remain challenging.

METHODS

Literature on the epidemiology, impact, and management of obesity in individuals with SCI was reviewed.

FINDINGS

Although nearly 66% of individuals with SCI are either overweight or obese, little guidance is available to measure and monitor obesity in the clinical setting. The use of anthropometric indices and specific cut points available for able-bodied persons is limited by the body composition changes that follow SCI. Indices of upper body obesity warrant examination in SCI because they provide an index of central obesity, which is more closely linked to some obesity-related conditions than is overall obesity. Investigations into the sequelae of excess body fat and its distribution are also needed in SCI because past research in this area has been inconclusive. Although limited, evidence regarding obesity interventions in SCI may be promising.

CONCLUSIONS

The best anthropometric tool to define obesity in the clinical setting remains unknown. SCI-specific assessment tools and a better understanding of the sequelae of excess body weight will lead to better targeting of prevention and treatment efforts. More research is needed on the individual components of a weight management program unique to SCI. Until then, providers are urged to use a team approach and draw on existing resources and applicable research in able-bodied individuals to facilitate weight management in individuals with SCI.

Establishing evidence-based physical activity guidelines: methods for the Study of Health and Activity in People with Spinal Cord Injury (SHAPE SCI)

STUDY DESIGN

Prospective, observational cohort study.

OBJECTIVES

This paper describes the rationale and methodology for the Study of Health and Activity in People with Spinal Cord Injury (SHAPE SCI). The study aims to (1) describe physical activity levels of people with different injury levels and completeness, (2) examine the relationship between physical activity, risk and/or presence of secondary health complications and risk of chronic disease, and (3) identify determinants of physical activity in the SCI population.

SETTING

Ontario, Canada.

METHODS

Seven hundred and twenty men and women who have incurred a traumatic SCI complete self-report measures of physical activity, physical activity determinants, secondary health problems and subjective well-being during a telephone interview. A representative subsample (n=81) participate in chronic disease risk factor testing for obesity, insulin resistance and coronary heart disease. Measures are taken at baseline, 6 and 18 months.

CONCLUSION

SHAPE SCI will provide much-needed epidemiological information on physical activity patterns, determinants and health in people with SCI. This information will provide a foundation for the establishment of evidence-based physical activity guidelines and interventions tailored to the SCI community.

The physical activity recall assessment for people with spinal cord injury: validity

PURPOSE

This study examined the construct validity of the physical activity recall assessment for people with spinal cord injury (PARA-SCI).

METHODS

First, to assess convergent validity, relationships between PARA-SCI scores and measures of aerobic fitness and muscular strength were examined among 73 men and women with SCI. Second, extreme groups analyses were conducted. PARA-SCI scores from 158 people with SCI were compared between groups differing on demographic, disability, and behavioral characteristics.

RESULTS

Scores from the leisure time physical activity (LTPA) and cumulative activity PARA-SCI categories correlated positively with parameters of aerobic fitness and muscular strength. Scores from the lifestyle activity PARA-SCI category were not consistently associated with fitness parameters. LTPA category scores could differentiate between groups differing by age, sex, gym or sports team membership, and frequency of participation in LTPA. Lifestyle and cumulative activity scores were unable to distinguish between most groups.

CONCLUSION

The convergent validity study provided evidence of validity for the PARA-SCI LTPA and cumulative activity categories. The extreme groups analyses provided further evidence of the validity of the LTPA category by demonstrating differences in extreme groups. Together, these findings contribute to the accumulating evidence of the construct validity of the PARA-SCI LTPA category and its utility for assessing LTPA among individuals with SCI. These results also highlight measurement constraints of the lifestyle activity and cumulative activity categories.