Direct referral and physical activity counselling upon discharge from spinal cord injury rehabilitation

Virtual walking therapy in neuropathic spinal cord injury pain: a feasibility study

STUDY DESIGN

A feasibility study.

OBJECTIVES

Chronic neuropathic pain is a prevalent comorbidity in patients with spinal cord injury (SCI), and current medical treatments remain unsatisfactory. New developments as virtual walking are emerging which has been established and further developed at our centre. This study aims to investigate the feasibility of our virtual walking setup in a small group of SCI patients.

SETTING

The study was conducted at the Swiss Paraplegic Centre in Nottwil, Switzerland.

METHODS

Four patients aged 22 to 60 years were observed during and after therapy. Three had complete paraplegia (levels Th4-Th8) with neuropathic at- and below-level pain, while one had incomplete paraplegia (Th10) with at-level pain. The primary outcome measured was satisfaction with acceptance of and adherence to virtual walking therapy, alongside suggestions for therapy improvements. Additionally, patients kept a pain diary and pain drawings to measure the extent of pain distribution and intensity before and after therapy. Therapy schedules included either two sessions per week for five weeks or five sessions per week for two weeks.

RESULTS

There was a sound satisfaction and good acceptance amongst participants. Support, duration, and number of sessions were perceived well and acceptable. Pain as a secondary outcome did not change during or after therapy in all but one patient which improved in pain intensity, pain quality as well as pain distribution.

CONCLUSION

Results suggest that our virtual walking setting is a feasible tool that should be further studied in patients with SCI-related chronic neuropathic pain.

Exercise prescription for persons with spinal cord injury: a review of physiological considerations and evidence-based guidelines

Persons with spinal cord injury (SCI) experience gains in fitness, physical and mental health from regular participation in exercise and physical activity. Due to changes in physiological function of the cardiovascular, nervous, and muscular systems, general population physical activity guidelines and traditional exercise prescription methods are not appropriate for the SCI population. Exercise guidelines specific to persons with SCI recommend progressive training beginning at 20 min of moderate to vigorous intensity aerobic exercise twice per week transitioning to 30 min three times per week, with strength training of the major muscle groups two times per week. These population-specific guidelines were designed considering the substantial barriers to physical activity for persons with SCI and can be used to frame an individual exercise prescription. Rating of perceived exertion (i.e., perceptually regulated exercise) is a practical way to indicate moderate to vigorous intensity exercise in community settings. Adapted exercise modes include arm cycle ergometry, hybrid arm-leg cycling, and recumbent elliptical equipment. Body weight-supported treadmill training and other rehabilitation modalities may improve some aspects of health and fitness for people with SCI if completed at sufficient intensity. Disability-specific community programs offer beneficial opportunities for persons with SCI to experience quality exercise opportunities but are not universally available.

Influence of Sociodemographic Factors, Health Conditions, and Activity on Participation in People With Spinal Cord Injury in South Korea

OBJECTIVE

To verify the causal relationship between sociodemographic factors, health conditions, and activities that influence the participation of people with spinal cord injury (SCI) using International Spinal Cord Injury (InSCI) Survey data and to investigate the moderation effects of environmental restrictions and health care system concerns.

DESIGN

Cross-sectional community survey and structural equation model.

SETTING

SCI databases of the Korea National Rehabilitation Center and Korea Spinal Cord Injury Association.

PARTICIPANTS

Community-dwelling adults (N=890) with SCI.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The InSCI questionnaire domains included sociodemographic factors, health conditions, activity, participation, environmental restrictions, and health system concerns. Sociodemographic factors included age, education, and income. Health conditions included bowel dysfunction, respiratory problems, and pain, among others. Activity included "daily routine" and "using hands," among others. Participation included "interacting with people" and "intimate relationships," among others. Environmental restrictions included "public places" and "negative attitudes," among others. Health care system concerns included "nursing care" and "experience of being treated," among others.

RESULTS

The hypothesis that health conditions would have a significant effect on activity was supported because 51% of the total variance in activity factors was explained by health condition factors. The hypothesis that activity would have a significant effect on participation was also supported because 63.4% of total variance in participation factors was explained by activity factors. The moderation effect tests supported the hypotheses that health conditions, activity, and participation would differ depending on the extent of environmental restrictions as well as the extent of health system concerns.

CONCLUSIONS

When formulating policies and recommendations to promote the participation of people with SCI living in the South Korean community, the influence of environmental restrictions and health systems as well as the causal influence of health conditions and activity should be considered.

Physical activity promotion to persons with spinal cord injury by health and exercise professionals: A scoping review

OBJECTIVES

Health and exercise professionals (HEPs) are ideal promoters and valued messengers of physical activity (PA) information among persons with spinal cord injury (SCI). However, little is known about what strategies used by HEPs increase PA behavior in persons with SCI, or what factors influence HEPs when promoting PA to persons with SCI. The purposes of this scoping review were to (1) ascertain the extent, range and nature of the literature, (2) identify strategies used by HEPs that are associated with an increase in PA behavior for persons with SCI, and (3) identify the facilitators and barriers to PA promotion by the HEPs.

METHODS

A comprehensive search was undertaken. Search terms were expanded surrounding three key terms: PA, promotion, and SCI.

RESULTS

Twenty-four articles representing 18 unique studies were identified. HEPs predominantly consisted of physiotherapists, occupational therapists, and leisure trainers/therapists. Most interventions were delivered by HEPs to persons with SCI in in-patient rehabilitation centres and community-based settings. Tailored exercise programs and on-going counseling support were considered essential for increasing PA behavior. HEPs' common barriers to PA promotion were perceived lack of time, education, and training.

CONCLUSION

A need to improve and sustain SCI-specific PA knowledge and education was identified if PA promotion is to become a structured and integral component of practice. This study provides valuable information for interventions to increase PA behavior among persons with SCI by improving PA promotion by HEPs.

Smartphone-Delivered Peer Physical Activity Counseling Program for Individuals With Spinal Cord Injury: Protocol for Development and Pilot Evaluation

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

Effects of Graded Exercises Integrated with Education on Physical Fitness, Exercise SelfEfficacy, and Activity Levels in People with Spinal Cord Injury: A Quasi-Experimental Study Protocol

Study Design

A quasi-experimental single-blinded study.

Purpose

To investigate the effects of ‘graded exercise integrated with education’ on physical fitness, exercise self-efficacy (ESE), and physical activity (PA) levels among subacute and chronic wheelchair-dependent paraplegia patients.

Overview of Literature

Most of the chronic spinal cord injury (SCI) patients had low physical fitness due to a sedentary lifestyle and lack of ESE after discharge from a rehabilitation program. Education may encourage them to engage with exercise to regain and maintain their physical fitness. However, there is a lack of research to support the effects of exercise integrated with education after an SCI.

Methods

A total of 44 participants will be assigned to either the experimental group (graded exercise integrated with education) or active control (conventional physical therapy). The experimental group will receive graded strength and aerobic exercise training according to their progression criteria. They will attend an education program during and after the rehabilitation program. The control group will only receive conventional physical therapy during their in-rehabilitation program. This study will be conducted during a period of 16 weeks, consisting of 8 weeks of in-rehabilitation and 8 weeks post-rehabilitation. Statistical analysis will be performed using the IBM SPSS ver. 21.0 (IBM Corp., Armonk, NY, USA) at a significance level of p≤0.05.

Results

The primary outcome measures will be upper-limb isokinetic strength, isometric grip strength, and cardiorespiratory fitness. The secondary outcomes will be ESE and PA levels.

Conclusions

An intervention that combines exercise training and education may be warranted to enhance the physical fitness, ESE, and PA levels in SCI patients. This trial was registered with ClinicalTrials.gov (NCT03420170).

Community exercise programing and its potential influence on quality of life and functional reach for individuals with spinal cord injury

Context/Objective: After an individual with a Spinal Cord Injury (SCI) participates in the initial rehabilitation process, they often experience limited access to physical therapy services and other fitness activities. The purpose of this study was to examine previously collected data for changes in quality of life (QoL) and functional reach in individuals with SCI following an 8-week community exercise program.Design: Secondary analysis of previously collected data.Setting: Community-based exercise program.Participants: Twenty-two participants with an average of 9 years post-SCI, both complete and incomplete injuries, and injury levels ranging from C2 to L5.Interventions: Participants completed an 8-week program, once per week for 4 hours that included a four-station circuit of resistance training, aerobic exercise, trunk stability, and education.Outcome Measures: Physical function was measured using the modified Functional Reach Test (mFRT). QoL was measured with the Life Satisfaction Questionnaire-9 (LiSAT-9).Results: The mFRT improved by 2 inches (±7.04) P < 0.001 and QoL improved as well, P < 0.001.Conclusion: The findings of this study are consistent with the hypothesis that a supervised post-rehabilitation community exercise program, like Spinal Mobility, may positively impact the QoL and functional reach in individuals with SCI.

Barriers and facilitators to adhering to an anti-inflammatory diet for individuals with spinal cord injuries

The purpose of this study was to explore the barriers and facilitators of an anti-inflammatory diet in people with spinal cord injury. Six participants (age range of 23-68 years, three women and three men) who had previously completed an anti-inflammatory diet study were interviewed. Facilitators identified were family support, autonomy over meal choice, peer support, health benefits gained, and implementation of adherence strategies. The main barriers discussed were lack of motivation after study period ended, social events, diet expenses, and lack of knowledge about the diet. Several health benefits including reductions in pain, edema, and improvements in cognition and mobility were reported.

Life after personalized adaptive locomotor training: a qualitative follow-up study

STUDY DESIGN

Qualitative follow-up study.

OBJECTIVES

Intensive locomotor training can improve physical and psychological functioning for individuals with spinal cord injury. Few studies have examined long-term effects of locomotor training. Specifically, there is a lack of qualitative follow-up that provide insight into participants' perceptions of the effects of locomotor training on level of function and daily life. This study aimed to gain insight into participants' perceptions of intensive locomotor training and whether participation influenced the level of function and community living 1-2 years after training.

SETTING

Tertiary rehabilitation facility in Ontario, Canada.

METHODS

Participants were six individuals who had lived with spinal cord injury between 1.9 and 2.7 years at the time of the interviews and had completed locomotor training during the subacute phase of injury. Semi-structured interviews explored participants' daily experiences and level of function after locomotor training. Interviews were analyzed using thematic analysis.

RESULTS

Three themes were identified. (1) Outcomes: Personalized Adapted Locomotor Training led to transferable gains from the program to daily functioning and eased transitions out of the rehabilitation hospital. (2) Continuing the rehabilitation journey: following disappointment after training ended, recovery was perceived incomplete regardless of current functional status. Endeavors were now directed to maintaining gains achieved during the program. (3) Challenges: since discharge from Personalized Adapted Locomotor Training, participants identified changes in their psychological well-being and the risk of falls as challenges.

CONCLUSIONS

Personalized Adapted Locomotor Training was a positive experience. The identified challenges present future opportunities for the improved delivery of intensive locomotor training programs.

Current Trends in Exercise Intervention Research, Technology, and Behavioral Change Strategies for People With Disabilities: A Scoping Review

This review synthesized physical activity and exercise intervention literature for the past 10 yrs for people with physical and cognitive disabilities including intervention characteristics, behavior change strategies, and types of technologies used to improve targeted outcomes. Systematic searches yielded 132 eligible studies. The major disability groups were multiple sclerosis (41%), stroke (15%), and spinal cord injury (12%). Research designs primarily involved randomized controlled trials (61%) versus quasi-experimental designs (39%). Approximately 20% of the interventions used some form of the following technology: information and communication technology (48%), interactive technology (37%), or electronic gauges (30%). Eighteen percent of studies used intervention strategies based on behavioral theory, which was typically combined with technology to promote activity and increase adherence in generally larger study samples. The three prevailing theories included social cognitive theory (58%), supportive accountability theory (21%), and transtheoretical model (21%). Upon completing the intervention, studies reported primarily significant outcomes (80%). Exercise research for PWD has grown in both quantity and quality, but several gaps remain. Study findings provide a roadmap for future exercise trials on understudied populations and highlight technology and behavior change theory as drivers of future intervention research.

Framing new pathways in transformative exercise for individuals with existing and newly acquired disability

PURPOSE

This paper describes a continuum of customized exercise options for people with an existing and newly acquired disability or diagnosis referred to as the Transformative Exercise Framework.

BACKGROUND

The period directly after rehabilitation is a critical juncture where many individuals return to life with high rates of sedentary behavior. After rehabilitation discharge, people with newly acquired disability or diagnoses often never make the transition into usage of community-based exercise services that are tailored, safe and effective.

METHODS

Narrative review.

RESULTS

The Transformative Exercise Framework supports a patient-to-participant, rehab-to-wellness model that emphasizes a linkage between physical and occupational therapists and community-based exercise trainers. The four focus areas - Rehabilitation, Condition-specific Exercise, Fitness and Lifetime Physical Activity - emphasize a range of options for people with newly acquired disability and diagnoses, or for people with existing disability and/or chronic health conditions who have a new injury, secondary condition or are severely deconditioned.

CONCLUSION

The concept of transformative exercise is to support people with disabilities and diagnoses with a seamless restore-improve-prevent continuum of programs and services. This continuum connects individuals to rehabilitation and exercise professionals in a dynamic framework, which maximizes the expertise of both sets of professionals and provides the most effective interventions to achieve the greatest gains in health and function and/or to avoid future health decline. Implications for Rehabilitation Patients discharged from rehabilitation should be transformed into participants in lifelong physical activity through a continuum of health services, which we refer to as Transformative Exercise. Transformative exercise is a continuum of individually tailored exercise strategies/programs that aims to improve the function of underperforming systems, which inhibit community and/or lifelong physical activity participation. The Transformative Exercise Framework can be used by a therapist or exercise trainer to design a program that maximizes performance and time and is based on a specific process for identifying short and long term goals.