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Waller M, Lexell J, Martin Ginis KA, Jörgensen S. Leisure time physical activity in middle-aged and older adults aging with long-term spinal cord injury: Changes over six years. Disabil Health J 2024:101648. [PMID: 38910042 DOI: 10.1016/j.dhjo.2024.101648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/20/2024] [Accepted: 06/05/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Regular leisure time physical activity (LTPA) has beneficial health effects in people with spinal cord injury (SCI). Yet, participation in LTPA is low, and little is known about changes many years after injury. OBJECTIVES To determine changes in LTPA in middle-aged and older adults with long-term SCI over six years, investigate associations with gender, age, injury characteristics and changes in secondary health conditions and activity limitations, and investigate factors related to being physically active or sedentary. METHODS Part of the Swedish Aging with Spinal Cord Injury Study (SASCIS). LTPA was assessed twice over a six-year period with the Physical Activity Recall Assessment for people with Spinal Cord Injury (n = 75; 32% women, mean age 67 years, mean time since injury 31 years, injury levels C1-L3, AIS A-D). Changes were assessed with paired t-tests, McNemar test and Wilcoxon signed-rank test, associations with multivariable regression and group comparisons with Mann-Whitney U test and Chi Square test. RESULTS On group level participation in LTPA did not change, but the variability was substantial on individual level. There were no significant associations between changes in LTPA and the investigated variables. Among sedentary participants, higher level and severity of injury were overrepresented and the activity limitations were greater. CONCLUSIONS Our findings indicate stability in LTPA over time, but with a large individual variation. In many participants LTPA was insufficient to reach positive health effects. Promoting participation in LTPA is therefore an important part of the long-term management of middle-aged and older adults aging with long-term SCI.
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Affiliation(s)
- Mikael Waller
- Department of Health Sciences, Lund University, Box 157, SE-221 00, Lund, Sweden; Department of Rehabilitation Medicine, Sunderby Hospital, Norrbotten County Council, 971 80, Luleå, Sweden.
| | - Jan Lexell
- Department of Health Sciences, Lund University, Box 157, SE-221 00, Lund, Sweden.
| | - Kathleen A Martin Ginis
- Department of Medicine, Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC, Canada; School of Health and Exercise Sciences, University of British Columbia, Faculty of Health and Social Development, Okanagan Campus, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada; Centre for Chronic Disease Prevention and Management, Kelowna, BC, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
| | - Sophie Jörgensen
- Department of Health Sciences, Lund University, Box 157, SE-221 00, Lund, Sweden; Department of Rehabilitation Medicine, Skåne University Hospital, 221 85, Lund, Sweden.
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2
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Craven BC, Souza WH, Jaglal S, Gibbs J, Wiest MJ, Sweet SN, Athanasopoulos P, Lamontagne ME, Boag L, Patsakos E, Wolfe D, Hicks A, Maltais DB, Best KL, Gagnon D. Reducing endocrine metabolic disease risk in adults with chronic spinal cord injury: strategic activities conducted by the Ontario-Quebec RIISC team. Disabil Rehabil 2023:1-13. [PMID: 38018518 DOI: 10.1080/09638288.2023.2284223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE The Rehabilitation Interventions for Individuals with a Spinal Cord Injury in the Community (RIISC) team aimed to develop and evaluate innovative rehabilitation interventions to identify endocrine metabolic disease (EMD) risk, intending to reduce the frequency and severity of EMD related morbidity and mortality among adults living with chronic spinal cord injury or disease (SCI/D). MATERIALS AND METHODS An interprovincial team from Ontario and Quebec reviewed available EMD literature and evidence syntheses and completed an inventory of health services, policies and practices in SCI/D care. The review outcomes were combined with expert opinion to create an EMD risk model to inform health service transformation. RESULTS EMD risk and mortality are highly prevalent among adults with chronic SCI/D. In stark contrast, few rehabilitation interventions target EMD outcomes. The modelled solution proposes: 1) abandoning single-disease paradigms and examining a holistic perspective of the individual's EMD risk, and 2) developing and disseminating practice-based research approaches in outpatient community settings. CONCLUSIONS RIISC model adoption could accelerate EMD care optimization, and ultimately inform the design of large-scale longitudinal pragmatic trials likely to improve health outcomes. Linking the RIISC team activities to economic evaluations and policy deliverables will strengthen the relevance and impact among policymakers, health care providers and patients.
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Affiliation(s)
- Beverley Catharine Craven
- Toronto Rehabilitation Institute, Lyndhurst Centre, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Wagner Henrique Souza
- Kite Research Institute, University Health Network, Lyndhurst Centre, Toronto, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Jenna Gibbs
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | | | - Shane N Sweet
- Department of Kinesiology & Physical Education, McGill University, Montreal, Canada
| | - Peter Athanasopoulos
- Senior Manager Public Policy and Government Relations, Spinal Cord Injury Ontario, Toronto, Canada
| | | | - Lynn Boag
- University of Guelph, Guelph, Canada
| | - Eleni Patsakos
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Dalton Wolfe
- Department of Physical Medicine and Rehabilitation, Western University, Parkwood Institute Research, London, Canada
| | - Audrey Hicks
- Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Désirée B Maltais
- Department of Rehabilitation, Physiotherapy Program, Laval University, Quebec City, Canada
| | - Krista Lynn Best
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Dany Gagnon
- School of Rehabilitation, Université de Montréal, Montréal, Canada
- Centre for Interdisciplinary Research in Rehabilitation, Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Montréal, Canada
- Rehabilitation, Université de Montréal, École de Réadaptation, Montréal, Canada
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3
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Gingrich N, Bosancich J, Schmidt J, Sakakibara BM. Capability, opportunity, motivation, and social participation after stroke. Top Stroke Rehabil 2022; 30:423-435. [PMID: 35510695 DOI: 10.1080/10749357.2022.2070358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Stroke survivors report limited social participation, despite it being an important rehabilitation outcome. Interdisciplinary interventions for increasing social participation amongst stroke survivors lack theoretical guidance and evidence-based approaches. The Behavior Change Wheel (BCW) theorizes that capability, opportunity, and motivation contribute to behavior change. OBJECTIVES This study applied the BCW to understand the relationship between social participation and stroke survivors' capability, opportunity, and motivation. METHODS In this cross-sectional study, we recruited 30 community-dwelling adult stroke survivors. Assessments explored the frequency and satisfaction of social participation; physical and psychological capability; environmental accessibility and social opportunity; and motivation. A linear regression analysis was done. RESULTS Motivation (R2 change = 29.3%, ß = 0.55) and environmental opportunity (R2 change = 11%, ß = 0.39) were statistically significant predictors of social participation frequency. Motivation (R2 change = 36.9%, ß = 0.61) was the only statistically significant predictor of satisfaction with social performance. CONCLUSIONS Motivation and environmental accessibility are statistically significant independent predictors of frequency of social participation after stroke. Motivation is the strongest predictor of satisfaction with social participation. Clinicians may support stroke survivors to promote social participation using approaches that increase motivation and environmental accessibility. Development of such theoretically sound interventions may be guided by the BCW.
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Affiliation(s)
- Nicole Gingrich
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacob Bosancich
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julia Schmidt
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Brodie M Sakakibara
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.,Centre for Chronic Disease Prevention and Management, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
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4
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Juul-Kristensen B, Bech C, Liaghat B, Cools AM, Olsen HB, Søgaard K, Larsen CM. Assessment of shoulder rotation strength, muscle co-activation and shoulder pain in tetraplegic wheelchair athletes - A methodological study. J Spinal Cord Med 2022; 45:410-419. [PMID: 32808885 PMCID: PMC9135435 DOI: 10.1080/10790268.2020.1803659] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objective: To develop a feasible protocol for testing maximum shoulder rotation strength in tetraplegic wheelchair athletes, and investigate concurrent validity of maximum isometric handheld dynamometer (HHD) towards maximum isokinetic dynamometer (ID) strength measurements; secondly, to study shoulder muscle activation during maximum shoulder rotation measurements, and the association between shoulder strength and shoulder pain.Design: Descriptive methodological.Setting: Danish Wheelchair Rugby (WCR) association for WCR tetraplegic athletes from local WCR-clubs.Participants: Twelve adult tetraplegics.Interventions: N/A.Outcome measures: Wheelchair User's Shoulder Pain Index (WUSPI) and Visual Analog Scale (VAS) measured shoulder pain, isometric HHD and ID (60°/s) measured maximum internal (IR) and external (ER) shoulder rotation strength. Surface Electromyography normalized to maximum EMG measured muscle activity (mm Infraspinatus and Latissimus Dorsi) during maximum shoulder rotation strength.Results: Concurrent validity of isometric HHD towards ID showed Concordance Correlation Coefficients of left and right arms 0.90 and 0.86 (IR), and 0.89 and 0.91 (ER), with no difference in muscle activity between isometric HHD and ID, but larger co-activation during ER. There was no association between shoulder strength and pain, except for significantly weak negative associations between ID and pain during ER for left and right arms (P = 0.03; P = 0.04).Conclusion: Standardized feasible protocol for tetraplegic wheelchair athletes for measuring maximum shoulder rotation strength was established. Isometric HHD is comparable with ID on normalized peak torques and muscle activity, but with larger co-activation. Strength was not clearly associated with shoulder pain.
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Affiliation(s)
- Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Claus Bech
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Behnam Liaghat
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Ann M. Cools
- Department of Rehabilitation Sciences and Physiotherapy, Gent University, Gent, Belgium
- Department of Occupational and Physical Therapy & Institute of Sports Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henrik B. Olsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Occupational and Environmental Medicine, University Hospital, Odense, Denmark
| | - Camilla M. Larsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Health Sciences Research Centre, University College, Odense, Denmark
- Department of Physiotherapy, University College, Odense, Denmark
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Wilroy JD, Lai B, Davlyatov G, Mehta T, Thirumalai M, Rimmer JH. Correlates of adherence in a home-based, self-managed exercise program tailored to wheelchair users with spinal cord injury. Spinal Cord 2020; 59:55-62. [PMID: 32541883 DOI: 10.1038/s41393-020-0497-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional design. OBJECTIVES To examine personal factors, secondary health conditions, and environmental factors as potential correlates of adherence to a 12-week home-based exercise trial in people with spinal cord injury. SETTING Home METHODS: Participants (n = 28) were prescribed a set of exercise videos that they were asked to complete three times each week for 12 weeks (36 total sessions). The videos were accessible through a custom-designed mobile application and included movements targeting strength, cardiorespiratory fitness, and balance that were accompanied with music. Watched video minutes were automatically recorded on the web-based platform. At baseline, participants completed self-report questionnaires that measured personal (e.g., age, self-efficacy) and environmental (e.g., barriers) factors and secondary health conditions (e.g., depression). Data were analyzed using quantile (median) regression analysis. RESULTS Race (African American; β = -65.62, p = 0.004), community barriers (β = -9.12, p = 0.026), anxiety (β = -3.84, p = <0.001), depression (β = -1.42, p = 0.038), physical function (β = -1.35, p = 0.048), and self-efficacy (β = -0.61, p = 0.007) were associated with a lower number of exercise video minutes. Pain intensity (β = 2.03, p = 0.032), pain interference (β = 1.84, p = 0.012), and age (β = 1.13, p = 0.013) were associated with a higher number of exercise video minutes. Total variance explained by the model was 77% (pseudo R2 = 0.77). CONCLUSIONS Factors associated with lower and higher adherence to home-based exercise should guide future research efforts in creating more precision-based approaches for self-managed home exercise.
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Affiliation(s)
- Jereme D Wilroy
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35233, USA.
| | - Byron Lai
- Division of Pediatric Rehabilitation Medicine, Children's of Alabama Hospital, Birmingham, AL, 35233, USA
| | - Ganisher Davlyatov
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Tapan Mehta
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Mohanraj Thirumalai
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - James H Rimmer
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
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Shirazipour CH, Latimer-Cheung AE, Aiken AB. Quality physical activity experiences for military Veterans with a physical disability: Exploring the relationship among program conditions, elements, and outcomes. JOURNAL OF MILITARY VETERAN AND FAMILY HEALTH 2019. [DOI: 10.3138/jmvfh.2018-0017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: In this study, we evaluate the physical activity (PA) participation of Veterans with a physical disability, particularly the role of experiential elements of quality participation in facilitating desired program outcomes. We hypothesized that quality elements would mediate the relationship between quality program conditions and participation outcomes. Methods: Forty-nine Veterans with a physical disability (mean age = 43.61 [SD 8.81] y) completed questionnaires before and after PA event participation, as well as at a 3-month follow-up. Results: Results demonstrated that an indicator of the quality element belongingness mediated the relationship between coach interpersonal skills and two PA indicators (i.e., planning and intentions) after event participation. The same quality indicator also mediated the relationship between coach interpersonal skills and family integration after event participation and at the 3-month follow-up. Discussion: These findings provide preliminary evidence linking quality PA program conditions and elements to PA participation outcomes.
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Affiliation(s)
- Celina H. Shirazipour
- Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, California, USA
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada
| | - Amy E. Latimer-Cheung
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada
| | - Alice B. Aiken
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
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7
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Kooijmans H, Post M, Motazedi E, Spijkerman D, Bongers-Janssen H, Stam H, Bussman H. Exercise self-efficacy is weakly related to engagement in physical activity in persons with long-standing spinal cord injury. Disabil Rehabil 2019; 42:2903-2909. [PMID: 30907149 DOI: 10.1080/09638288.2019.1574914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aims: Many people with a long-standing spinal cord injury have an inactive lifestyle. Although exercise self-efficacy is considered a key determinant of engaging in exercise, the relationship between exercise self-efficacy and physical activity remains unclear. Therefore, this study examines the relationship between exercise self-efficacy and the amount of physical activity in persons with long-standing spinal cord injury.Methods: This cross-sectional study included 268 individuals (aged 28-65 years) with spinal cord injury ≥ 10 years and using a wheelchair. Physical activity was measured with the Physical Activity Scale for Individuals with Physical Disabilities. Exercise self-efficacy was assessed with the Spinal cord injury Exercise Self-Efficacy Scale. Univariate and multivariable regression analyses were performed to test for the association between exercise self-efficacy and physical activity, controlling for supposed confounders.Results: Univariate regression analysis revealed that exercise self-efficacy was significantly related to the level of daily physical activity (β = 0.05; 95% CI 0.04-0.07; 15% explained variance; p < 0.001). In multivariable regression analysis exercise self-efficacy remained, explaining a significant additional amount of the variance (2%; p < 0.001) of physical activity.Conclusion: Exercise-self efficacy is a weak but independent explanatory factor of the level of physical activity among persons with long-standing spinal cord injury. Longitudinal trials are needed to study the impact of interventions targeting an increase of exercise self-efficacy on the amount of physical activity performed.Implications for rehabilitationPre-intervention levels of exercise-self-efficacy might mediate the effectiveness of interventions that aim at increasing physical activities in people with a long-standing spinal cord injury.Enhancing exercise-self efficacy may improve levels of physical activity, even in people with a long-standing spinal cord injury.When it comes to enhancing physical activity, efforts to enhance non-structured daily physical activities such as household activities and gardening might be as important as efforts to enhance sports and other physical exercise.
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Affiliation(s)
| | - Marcel Post
- De Hoogstraat Center of Excellence in Rehabilitation Medicine, Utrecht, Netherlands
| | - Ehsan Motazedi
- Plant Sciences Group, Wageningen University and Research, Wageningen, Netherlands
| | | | | | - Henk Stam
- Erasmus MC, Rehabilitation Medicine, Rotterdam, Netherlands
| | - Hans Bussman
- Erasmus MC, Rehabilitation Medicine, Rotterdam, Netherlands
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8
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Best KL, Routhier F, Sweet SN, Lacroix E, Arbour-Nicitopoulos KP, Borisoff JF. Smartphone-Delivered Peer Physical Activity Counseling Program for Individuals With Spinal Cord Injury: Protocol for Development and Pilot Evaluation. JMIR Res Protoc 2019; 8:e10798. [PMID: 30901001 PMCID: PMC6450480 DOI: 10.2196/10798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/15/2018] [Accepted: 09/14/2018] [Indexed: 12/21/2022] Open
Abstract
Background Leisure-time physical activity (LTPA) is a critical component of a healthy lifestyle for individuals with spinal cord injury (SCI). However, most individuals are not sufficiently active to accrue health benefits. The Active Living Lifestyles program for individuals with SCI who use manual wheelchairs (ALLWheel) targets important psychological factors that are associated with LTPA uptake and adherence while overcoming some barriers associated with participation restrictions. Objective The goal of the paper is to describe the protocol for the development and evaluation of the ALLWheel program for individuals with SCI who use manual wheelchairs. Methods The first three stages of the Medical Research Council framework for developing and evaluating complex interventions (ie, preclinical, modeling, exploratory) are described. The preclinical phase will consist of scoping and systematic reviews and review of theory. The intervention will be modeled by expert opinions and consensus through focus groups and Delphi surveys with individuals with SCI, clinicians, and community partners. Finally, the feasibility and potential influence of the ALLWheel program on LTPA and psychological outcomes will be evaluated. Results This project is funded by the Craig H Neilsen Foundation, the Fonds de Recherche du Québec–Santé, and the Canadian Disability Participation Project and is currently underway. Conclusions Using peer trainers and mobile phone technology may help to cultivate autonomy-supportive environments that also enhance self-efficacy. Following a framework for developing and evaluating a novel intervention that includes input from stakeholders at all stages will ensure the final product (ie, a replicable intervention) is desirable to knowledge users and ready for evaluation in a randomized controlled trial. If effective, the ALLWheel program has the potential to reach a large number of individuals with SCI to promote LTPA uptake and adherence. International Registered Report Identifier (IRRID) DERR1-10.2196/10798
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Affiliation(s)
- Krista L Best
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Institut de Réadaptation en Déficience Physique de Québec, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale National, Quebec, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - François Routhier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Institut de Réadaptation en Déficience Physique de Québec, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale National, Quebec, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Shane N Sweet
- Department of Kinesiology & Physical Education, McGill University, Montreal, QC, Canada.,Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Montreal, QC, Canada
| | - Emilie Lacroix
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Institut de Réadaptation en Déficience Physique de Québec, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale National, Quebec, QC, Canada
| | | | - Jaimie F Borisoff
- Rehabilitation Engineering Design Laboratory, British Columbia Institute of Technology, Burnaby, BC, Canada.,International Collaboration on Repair Discoveries, Vancouver Coastal Health, Vancouver, BC, Canada
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DelGrande B, LaCoppola C, Moriello G, Sanicola K. Outcomes following an adaptive rock climbing program in a person with an incomplete spinal cord injury: A case report. Physiother Theory Pract 2019; 36:1466-1475. [PMID: 30870058 DOI: 10.1080/09593985.2019.1587799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: The purpose of this case report was to document outcomes following a rock climbing program for an individual with an incomplete spinal cord injury (SCI). Case Description: The participant was a 61 year-old male who sustained a C6 cervical AIS D SCI. Initially, he was only able to climb 30% of the rock wall with assistance and was unable to climb unassisted. Intervention: Outcome measures included muscle strength, arm girth, the Mini-Balance Evaluation Systems Test (Mini-BESTest), distance climbed, climbing performance, and the Quality of Life Profile for Adults with Physical Disabilities. The intervention included two 90-min sessions per week for 19 weeks. One session comprised traditional physical therapy and the second took place at an indoor rock climbing gym. Outcomes: Following the intervention, he was able to climb 100% of the wall with assistance and 48% unassisted. He made improvements in all categories of the quality of life scale, while changes in muscle strength and arm girth varied. No improvements were noted in balance. Conclusions: A task-based physical therapy program focusing on strengthening and rock climbing-specific activities improved the rock climbing ability of an individual with an incomplete cervical SCI.
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Affiliation(s)
- Brittany DelGrande
- Department of Physical Therapy, Glens Falls Hospital , Glens Falls, NY, USA
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10
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Mat Rosly M, Halaki M, Hasnan N, Mat Rosly H, Davis GM, Husain R. Leisure time physical activity participation in individuals with spinal cord injury in Malaysia: barriers to exercise. Spinal Cord 2018; 56:806-818. [DOI: 10.1038/s41393-018-0068-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/04/2018] [Accepted: 01/15/2018] [Indexed: 01/24/2023]
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11
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Bird ML, J Eng J, M. Sakakibara B. Predicting interest to use mobile-device telerehabilitation (mRehab) by baby-boomers with stroke. AIMS MEDICAL SCIENCE 2018. [DOI: 10.3934/medsci.2018.4.337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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12
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Physical Activity and Sedentary Behavior Subsequent to Serious Orthopedic Injury: A Systematic Review. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2017.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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13
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Arbour-Nicitopoulos KP, Sweet SN, Lamontagne ME, Ginis KAM, Jeske S, Routhier F, Latimer-Cheung AE. A randomized controlled trial to test the efficacy of the SCI Get Fit Toolkit on leisure-time physical activity behaviour and social-cognitive processes in adults with spinal cord injury. Spinal Cord Ser Cases 2017; 3:17044. [PMID: 28794901 DOI: 10.1038/scsandc.2017.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 05/31/2017] [Accepted: 06/27/2017] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Single blind, two-group randomized controlled trial. OBJECTIVES To evaluate the efficacy of the SCI Get Fit Toolkit delivered online on theoretical constructs and moderate-to-vigorous physical activity (MVPA) among adults with SCI. SETTING Ontario and Quebec, Canada. ELIGIBILITY Inactive, English- and French-speaking Canadian adults with traumatic SCI with Internet access, and no self-reported cognitive or memory impairments. METHODS Participants (N=90 Mage=48.12±11.29 years; 79% male) were randomized to view the SCI Get Fit Toolkit or the Physical Activity Guidelines for adults with SCI (PAG-SCI) online. Primary (intentions) and secondary (outcome expectancies, self-efficacy, planning and MVPA behaviour) outcomes were assessed over a 1-month period. RESULTS Of the 90 participants randomized, 77 were included in the analyses. Participants viewed the experimental stimuli only briefly, reading the 4-page toolkit for approximately 2.5 min longer than the 1-page guideline document. No condition effects were found for intentions, outcome expectancies, self-efficacy, and planning (ΔR2⩽0.03). Individuals in the toolkit condition were more likely to participate in at least one bout of 20 min of MVPA behaviour at 1-week post-intervention compared to individuals in the guidelines condition (OR=3.54, 95% CI=0.95, 13.17). However, no differences were found when examining change in weekly minutes of MVPA or comparing whether participants met the PAG-SCI. CONCLUSIONS No firm conclusions can be made regarding the impact of the SCI Get Fit Toolkit in comparison to the PAG-SCI on social cognitions and MVPA behaviour. The limited online access to this resource may partially explain these null findings.
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Affiliation(s)
| | - Shane N Sweet
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
| | - Marie-Eve Lamontagne
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Institut de Rédadaptation en Déficience Physique de Québec, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Montreal, Quebec, Canada.,Faculty of Medicine, Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada
| | - Kathleen A Martin Ginis
- School of Health and Exercise Sciences, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
| | - Samantha Jeske
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - François Routhier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Institut de Rédadaptation en Déficience Physique de Québec, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Montreal, Quebec, Canada.,Faculty of Medicine, Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada
| | - Amy E Latimer-Cheung
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
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Wilroy J, Turner L, Birch D, Leaver-Dunn D, Hibberd E, Leeper J. Development and evaluation of a social cognitive theory-based instrument to assess correlations for physical activity among people with spinal cord injury. Disabil Health J 2017; 11:62-69. [PMID: 28359637 DOI: 10.1016/j.dhjo.2017.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/15/2017] [Accepted: 03/09/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND People with spinal cord injury (SCI) are more susceptible to sedentary lifestyles because of the displacement of physical functioning and the copious barriers. Benefits of physical activity for people with SCI include physical fitness, functional capacity, social integration and psychological well-being. OBJECTIVE The purpose of this study was to develop and test a social cognitive theory-based instrument aimed to predict physical activity among people with SCI. METHODS An instrument was developed through the utilization and modification of previous items from the literature, an expert panel review, and cognitive interviewing, and tested among a sample of the SCI population using a cross-sectional design. Statistical analysis included descriptives, correlations, multiple regression, and exploratory factor analysis. RESULTS The physical activity outcome variable was significantly and positively correlated with self-regulatory efficacy (r = 0.575), task self-efficacy (r = 0.491), self-regulation (r = 0.432), social support (r = 0.284), and outcome expectations (r = 0.247). Internal consistency for the constructs ranged from 0.82 to 0.96. Construct reliability values for the self-regulation (0.95), self-regulatory efficacy (0.96), task self-efficacy (0.94), social support (0.84), and outcome expectations (0.92) each exceeded the 0.70 a priori criteria. CONCLUSIONS The factor analysis was conducted to seek modifications of current instrument to improve validity and reliability. The data provided support for the convergent validity of the five-factor SCT model. This study provides direction for further development of a valid and reliable instrument for predicting physical activity among people with SCI.
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Affiliation(s)
- Jereme Wilroy
- Research Department, Lakeshore Foundation, Birmingham, USA.
| | - Lori Turner
- Department of Health Science, University of Alabama, Tuscaloosa, USA
| | - David Birch
- Department of Health Science, University of Alabama, Tuscaloosa, USA
| | | | - Elizabeth Hibberd
- Department of Health Science, University of Alabama, Tuscaloosa, USA
| | - James Leeper
- Department of Health Science, University of Alabama, Tuscaloosa, USA
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Jörgensen S, Martin Ginis KA, Lexell J. Leisure time physical activity among older adults with long-term spinal cord injury. Spinal Cord 2017; 55:848-856. [PMID: 28322241 DOI: 10.1038/sc.2017.26] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES To describe participation in leisure time physical activity (LTPA) (amount, intensity and type) among older adults with long-term spinal cord injury (SCI), and to investigate the associations with sociodemographics, injury characteristics and secondary health conditions (SHCs). SETTING Home settings in southern Sweden. METHODS Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS). The physical activity recall assessment for people with SCI was used to assess LTPA among 84 men and 35 women (mean age 63.5 years, mean time since injury 24 years, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D). Associations were analyzed statistically using hierarchical multivariable regression. RESULTS Twenty-nine percent reported no LTPA, whereas 53% performed moderate-to-heavy intensity LTPA. The mean minutes per day of total LTPA was 34.7 (±41.5, median 15, range 0-171.7) and of moderate-to-heavy LTPA 22.5 (±35.1, median 5.0, range 0-140.0). The most frequently performed activities were walking and wheeling. Sociodemographics, injury characteristics and SHCs (bowel-related and bladder-related problems, spasticity and pain) explained 10.6% and 13.4%, respectively, of the variance in total and moderate-to-heavy LTPA. Age and wheelchair use were significantly, negatively associated with total LTPA. Women, wheelchair users and employed participants performed significantly less moderate-to-heavy LTPA than men, those using walking devices/no mobility device and unemployed participants. CONCLUSION Many older adults with long-term SCI do not reach the amount or intensity of LTPA needed to achieve fitness benefits. Research is needed on how to increase LTPA and to identify modifiable factors that could enhance their participation.
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Affiliation(s)
- S Jörgensen
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - K A Martin Ginis
- School of Health and Exercise Sciences, University of British Columbia, Okanagan Campus, Kelowna, BC, Canada
| | - J Lexell
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.,Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
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Are adults with spinal cord injury meeting the spinal cord injury-specific physical activity guidelines? A look at a sample from a Canadian province. Spinal Cord 2017; 55:454-459. [PMID: 28139660 DOI: 10.1038/sc.2016.181] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 08/24/2016] [Accepted: 11/13/2016] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN One cross-sectional study. OBJECTIVES To examine the extent to which a sample of adults with spinal cord injury (SCI) meet the SCI-specific physical activity guidelines and to identify potential demographic, injury and motivational characteristics related to participation. SETTING Quebec, Canada. METHODS A sample of 73 adults from the province of Quebec, Canada living with SCI completed the Leisure Time Physical Activity Questionnaire for People with Spinal Cord Injury to report their current frequency (sessions per week) and duration (minutes per session) in aerobic and resistance physical activity. RESULTS Results showed that 12% of participants in this sample met the guidelines and as many as 44% reported 0 min of physical activity. Only the participants' mode of mobility and autonomous motivation for physical activity emerged as a marginal correlate of the likelihood of meeting the physical activity guidelines. CONCLUSION Overall, physical activity participation rates among adults in this sample living with SCI remain quite low. Given the benefits of physical activity for adults with SCI, physical activity promotion efforts are needed.
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Associations with being physically active and the achievement of WHO recommendations on physical activity in people with spinal cord injury. Spinal Cord 2016; 55:235-243. [DOI: 10.1038/sc.2016.126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 11/09/2022]
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Wilroy J, Knowlden A. Systematic Review of Theory-Based Interventions Aimed at Increasing Physical Activity in Individuals With Spinal Cord Injury. AMERICAN JOURNAL OF HEALTH EDUCATION 2016. [DOI: 10.1080/19325037.2016.1158673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jereme Wilroy
- Department of Health Science, The University of Alabama
| | - Adam Knowlden
- Department of Health Science, The University of Alabama
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Health, Personal, and Environmental Predictors of Wheelchair-Use Confidence in Adult Wheelchair Users. Phys Ther 2015; 95:1365-73. [PMID: 25953595 PMCID: PMC4595810 DOI: 10.2522/ptj.20140537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/22/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND There are no predictive models of wheelchair-use confidence. Therefore, clinicians and researchers are limited in their ability to screen for and identify wheelchair users who may be more prone to low wheelchair-use confidence and may benefit from clinical intervention. OBJECTIVE The purpose of this study was to identify health-related, personal, and environmental factors that predict perceived wheelchair-use confidence in community-dwelling adults who use manual wheelchairs. DESIGN A cross-sectional study was conducted. METHODS Community-dwelling manual wheelchair users (N=124) were included in the study if they were ≥50 years of age, had ≥6 months of wheelchair use experience, and had no cognitive impairment. The Wheelchair Use Confidence Scale was used to assess wheelchair-use confidence. The sociodemographic information form, Functional Comorbidity Index, Seating Identification Tool, Interpersonal Support and Evaluation List, and Home and Community Environment Instrument captured the independent variables. Blocks of health, personal, and environmental variables were sequentially entered into the regression model. RESULTS Five personal variables (age, standardized beta [β]=-0.18; sex, β=-0.26; daily hours of wheelchair occupancy, β=0.20; wheelchair-use training, β=0.20; and wheelchair-use assistance, β=-0.34) and one environmental variable (need for seating intervention, β=-0.18) were statistically significant predictors, explaining 44% of the confidence variance. LIMITATIONS The sample comprised volunteers and, therefore, may underrepresent or overrepresent particular groups within the population. The study's cross-sectional research design does not allow for conclusions to be made regarding causality. CONCLUSION Older women who use wheelchairs and who require assistance with wheelchair use may have low wheelchair-use confidence. The same is true for individuals who have no formal wheelchair-use training, who are in need of a seating intervention, and who report few hours of daily wheelchair use. These wheelchair users may require clinical attention and benefit from intervention.
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Ploughman M, Harris C, Wallack EM, Drodge O, Beaulieu S, Mayo N. Predictors of exercise participation in ambulatory and non-ambulatory older people with multiple sclerosis. PeerJ 2015; 3:e1158. [PMID: 26339540 PMCID: PMC4558079 DOI: 10.7717/peerj.1158] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 07/15/2015] [Indexed: 11/20/2022] Open
Abstract
Background. Exercise at moderate intensity may confer neuroprotective benefits in multiple sclerosis (MS), however it has been reported that people with MS (PwMS) exercise less than national guideline recommendations. We aimed to determine predictors of moderate to vigorous exercise among a sample of older Canadians with MS who were divided into ambulatory (less disabled) and non-ambulatory (more disabled) groups. Methods. We analysed data collected as part of a national survey of health, lifestyle and aging with MS. Participants (n = 743) were Canadians over 55 years of age with MS for 20 or more years. We identified 'a priori' variables (demographic, personal, socioeconomic, physical health, exercise history and health care support) that may predict exercise at moderate to vigorous intensity (>6.75 metabolic equivalent hours/week). Predictive variables were entered into stepwise logistic regression until best fit was achieved. Results. There was no difference in explanatory models between ambulatory and non-ambulatory groups. The model predicting exercise included the ability to walk independently (OR 1.90, 95% CI [1.24-2.91]); low disability (OR 1.50, 95% CI [1.34-1.68] for each 10 point difference in Barthel Index score), perseverance (OR 1.17, 95% CI [1.08-1.26] for each additional point on the scale of 0-14), less fatigue (OR 2.01, 95% CI [1.32-3.07] for those in the lowest quartile), fewer years since MS diagnosis (OR 1.58, 95% CI [1.11-2.23] below the median of 23 years) and fewer cardiovascular comorbidities (OR 1.55 95% CI [1.02-2.35] one or no comorbidities). It was also notable that the factors, age, gender, social support, health care support and financial status were not predictive of exercise. Conclusions. This is the first examination of exercise and exercise predictors among older, more disabled PwMS. Disability is a major predictor of exercise participation (at moderate to vigorous levels) in both ambulatory and non-ambulatory groups suggesting that more exercise options must be developed for people with greater disability. Perseverance, fatigue, and cardiovascular comorbidities are predictors that are modifiable and potential targets for exercise adherence interventions.
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Affiliation(s)
- Michelle Ploughman
- Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University , St. John's, NL , Canada
| | - Chelsea Harris
- Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University , St. John's, NL , Canada
| | - Elizabeth M Wallack
- Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University , St. John's, NL , Canada
| | - Olivia Drodge
- Recovery and Performance Laboratory, Rehabilitation Research Unit, Faculty of Medicine, Memorial University , St. John's, NL , Canada
| | | | - Nancy Mayo
- Department of Clinical Epidemiology, McGill University , Montreal, QC , Canada
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Motl RW, Learmonth YC, Pilutti LA, Gappmaier E, Coote S. Top 10 research questions related to physical activity and multiple sclerosis. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2015; 86:117-129. [PMID: 25874730 DOI: 10.1080/02701367.2015.1023099] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
An estimated 2.5 million people worldwide are living with multiple sclerosis (MS), and this disease may be increasing in prevalence. MS is a disease of the central nervous system that is associated with heterogeneous symptoms and functional consequences, and the current first-line disease-modifying therapies often become ineffective later in the disease. There is increasing evidence for the benefits of physical activity (PA) in people with MS, but this population is generally physically inactive and sedentary. We proposed 10 research questions to guide future research on PA and MS: (1) Is PA an MS disease-modifying behavior? (2) What are the benefits of PA among people with MS? (3) What is the optimal PA prescription for people with MS? (4) What are the safety issues with PA in people with MS? (5) What characteristics of people with MS modify the benefits of PA? (6) What variables explain participation in PA among people with MS? (7) What are effective behavioral interventions for PA change in people with MS? (8) How do we translate PA research into clinical MS practice? (9) What is the role of sedentary behavior in people with MS? And (10) what is the optimal measurement of PA in people with MS? These questions are critical for informing our understanding of the short- and long-term consequences of PA in MS as well as for identifying approaches for promoting and sustaining PA in MS. Addressing these questions may greatly improve the lives of people with this chronic disease.
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Ginis KAM, Nigg CR, Smith AL. Peer-delivered physical activity interventions: an overlooked opportunity for physical activity promotion. Transl Behav Med 2013; 3:434-43. [PMID: 24294332 PMCID: PMC3830020 DOI: 10.1007/s13142-013-0215-2] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The purpose of this systematic review was to catalogue and synthesize published studies that have examined the effects of peer-delivered physical activity interventions on physical activity behavior. Ten published studies were identified that met the inclusion criteria. The following information was extracted from each study: study design and duration; characteristics of the sample, peers, and interventions; and physical activity outcomes. In all articles reporting within-groups analyses, peer-delivered interventions led to increases in physical activity behavior. When compared to alternatives, peer-delivered interventions were just as effective as professionally delivered interventions and more effective than control conditions for increasing physical activity. Only three studies included measures of social cognitive variables, yielding some evidence that peers may enhance self-efficacy and self-determined forms of motivation. Based on these findings, interventionists are encouraged to include peer mentors in their intervention delivery models. Investigators are encouraged to pursue a more comprehensive understanding of factors that can explain and maximize the impact of peer-delivered activity interventions.
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Affiliation(s)
- Kathleen A Martin Ginis
- />Department of Kinesiology, McMaster University, 1280 Main Street West, Ivor Wynne Centre E212, Hamilton, ON L8S 4K1 Canada
| | - Claudio R Nigg
- />Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI USA
| | - Alan L Smith
- />Department of Kinesiology, Michigan State University, East Lansing, MI USA
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Johnston M, Dixon D. Developing an integrated biomedical and behavioural theory of functioning and disability: adding models of behaviour to the ICF framework. Health Psychol Rev 2013; 8:381-403. [DOI: 10.1080/17437199.2013.855592] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Individuals with spinal cord injury (SCI) tend to report poorer quality of life (QOL) than people without a physical disability. Leisure-time physical activity (LTPA) has been shown to improve the QOL of people with and without disabilities and chronic conditions. The purpose of this systematic review was to examine the LTPA-QOL relationship among people with SCI by focusing on both objective and subjective QOL for both global QOL and domain-specifc (physical, psychological, social) QOL. Results suggest that LTPA is significantly associated with increases in both objective and subjective QOL in global QOL and all three QOL domains, with relatively few studies demonstrating a negative or nonsignificant relationship. Recommendations for future QOL research and interventions are discussed.
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