Determinants of handbike use in persons with spinal cord injury: results of a community survey in Switzerland

Association Between the Availability of Mobility Assistive Products and Participation Outcomes in Individuals With Spinal Cord Injury in Switzerland

Objectives

This study investigated the association between the reported availability of mobility assistive products and the perceived frequency, restriction, and satisfaction of participation in individuals with spinal cord injury in Switzerland.

Methods

This study was based on a cross-sectional analysis based on questionnaire data collected from the Swiss SCI Cohort Study community survey in 2012 (N = 492). The availability of 12 mobility assistive products were analyzed as the main predictor variable. The outcomes of interest were the frequency, restriction, and satisfaction of participation scales as measured by the 32-item Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P). The association between availability of mobility assistive products and participation was investigated using linear regressions analyses. All mobility assistive products were ranked in terms of relevance to improve participation by means of an importance performance plot.

Results

The availability of a sports wheelchair or a hand bike were both significant in reducing the restriction to participation. Having an adapted car increased the frequency of participation.

Conclusion

The availability of a sports wheelchair or a hand bike was significantly associated with less restriction in participation. With an unmet need of up to 36%, the known health benefits of regular physical activity and thereby cost-saving potential for the health care system, external support in the acquiring or use of these sports-related mobility assistive products could be an easy target for intervention.

Poetry in motion: Qualitative analysis, I-poems and disabled cyclists

In this article, I present three I-poems from a larger research project in which I explore the health, identity and social impacts of cycling for people with physical disabilities. I used I-poems as a means of kick-starting an in-depth, multi-perspective engagement with my interview transcripts after struggling to formulate insightful and productive thematic analysis. For me, this research project is something of a departure from my normal research processes and practices as it is taking place in partnership with a voluntary organisation. This organisation facilitated the recruitment of the research participants and had specific inputs into the research questions as well as maintaining ongoing interests in the research findings. My usual research tends to be much less structured and much more exploratory and messy than this. And yet, for me, this messiness facilitates insight and creative engagement which is intensely productive in terms of both findings and outputs – often via the use of creative methods. Therefore, as much as I have enjoyed conducting the research for this project and liaising with the organisation and meeting the participants, I struggled to find my ‘researcher mojo’ when working with the transcripts. In this context, I-poems became a creative stimulant for productive engagement with the transcripts and deepening my critical and reflective insights into the data.

Assessment of the Relationship between Selected Factors and Stress-Coping Strategies in Handcyclists-A Preliminary Study

Background and Objectives: Playing competitive sports is associated with stress, especially during the starting season. Disabled athletes are additionally burdened with physical and/or emotional factors, resulting from the trauma they have experienced. The aim of the work was to assess the relationship between strategies of coping with stress and the level of education, category of disability and its duration of handcyclists before the competition. Materials and Methods: 44 handcyclists with a mean age of 41.8 ± 11.6, from European countries, were divided according to the severity of mobility impairments, education and duration of the disability. The participants were asked to fill in the Mini-COPE Inventory for Measuring Coping with Stress, which provided answers in writing to some sociodemographic questions regarding age, sex, education, type of mobility impairment and duration of the disability. Results: The subjects who had suffered spinal injury at the cervical section obtained the lowest scores regarding their subjective assessment of their active stress management in difficult situations (p = 0.007). They scored the lowest, 1.5 points, when asked about acceptance in difficult circumstances compared to those with university education (p = 0.02). A statistically significant correlation was found to exist between education levels and positive revaluation, acceptance and seeking instrumental support. A negative correlation was observed between education and sustained use of psychoactive substances and denial. Conclusions: Highly educated cyclists with short-lasting disability, damage to the lower spine section or amputations tend to cope better with stress than other study participants.

Outcomes in socioeconomically disadvantaged patients with spinal cord injury: a systematic review

OBJECTIVEIndividuals with a spinal cord injury (SCI) in socioeconomically disadvantaged settings (e.g., rural or low income) have different outcomes than their counterparts; however, a contemporary literature review identifying and measuring these outcomes has not been published. Here, the authors' aim was to perform a systematic review and identify these parameters in the hope of providing tangible targets for future clinical research efforts.METHODSA systematic review was performed to find English-language articles published from 2007 to 2017 in the PubMed/MEDLINE, EMBASE, and SCOPUS databases. Studies evaluating any outcomes related to patients with an SCI and in a low-resource setting were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and a flowchart was created. Of the 403 articles found, 31 underwent complete review and 26 were eligible for study inclusion. According to the current study criteria, any case studies, studies in less developed countries, studies including and not separating other types of neurological disorders, studies not assessing the effects of a low-resource setting on outcomes in patients with SCI, and studies evaluating the causes of SCI in a low-resource setting were excluded.RESULTSIn SCI patients, a lower income was a predictor of death (OR 2.1, 95% CI 1.7-2.6, p = 0.0002). Moreover, secondary outcomes such as pain intensities (OR 3.32, 95% CI 2.21-4.49, p < 0.001), emergency room visits (11% more likely, p = 0.006), and pressure ulcer formation (OR 2.1, 95% CI 1.5-3.0, p < 0.001) were significantly higher in the lower income brackets. Rurality was also a factor and was significantly associated with increased emergency room visits (OR 1.5, 95% CI 1.1-2.1, p = 0.01) and lower outpatient service utilization (incidence rate ratio [IRR] 0.57, 95% CI 0.35-0.93, p < 0.05).CONCLUSIONSThe authors showed that individuals in a low-resource setting who have suffered an SCI have significantly different outcomes than their counterparts. These specific outcomes are promising targets for future research efforts that focus on improving health conditions among this population.

Effects of four-month handbike training under free-living conditions on physical fitness and health in wheelchair users

PURPOSE

Recognizing the encouraging effect of challenging events, the HandbikeBattle (HBB) was created to promote exercise among wheelchair users. The purpose of this study was to reveal the effects on physical fitness and health outcomes of four-month handbike training under free-living conditions in preparation for the event.

METHODS

In this prospective cohort study, 59 relatively inexperienced handyclists participated in the HBB of 2013 or 2014. Incremental exercise tests were conducted, respiratory function was tested and anthropometrics were measured before and after the preparation period. Main outcome measures were peak power output (POpeak), peak oxygen uptake (VO2peak) and waist circumference, of which the changes were tested using repeated measures ANOVA. To detect possible determinants of changes in physical fitness, a linear regression analysis was conducted with personal characteristics, executed training volume and upper-extremity complaints during the training period as independent variables.

RESULTS

POpeak, VO2peak and waist circumference improved significantly with 17%, 7% and 4.1%, respectively. None of the included variables were significant determinants for the changes in POpeak found as a result of the training.

CONCLUSION

A challenging event such as the HBB provokes training regimes among participants of sufficient load to realize substantial improvements in physical fitness and health outcomes. Implications for Rehabilitation Due to the often impaired muscle function in the lower-limbs and an inactive lifestyle, wheelchair users generally show considerably lower levels of fitness compared to able-bodied individuals. This prospective cohort study showed that four months of handbike training under free-living conditions in preparation for this event resulted in substantial improvements in physical fitness and health outcomes in wheelchair users. The creation of a challenging event such as the HandbikeBattle as part of a follow-up rehabilitation practice can therefore be a useful tool to help wheelchair users initiate or keep training to improve their physical fitness and health.

Need and use of assistive devices for personal mobility by individuals with spinal cord injury

OBJECTIVE

To investigate the provision, use, and unmet need of assistive devices for personal mobility in the Swiss population with spinal cord injury (SCI).

DESIGN

Community survey 2012 of the Swiss Spinal Cord Injury Cohort Study.

PARTICIPANTS

Individuals aged 16 or older with traumatic or non-traumatic SCI residing in Switzerland.

INTERVENTIONS

Not applicable.

OUTCOME MEASURES

Provision, frequency of use, and unmet need (i.e. perceiving the need of a device but it not being provided) of 11 mobility devices were assessed by self-report and analyzed descriptively. Provision of devices was further analyzed by sex, age, SCI etiology, SCI severity, and time since SCI.

RESULTS

Devices reported highest for provision (N = 492; mean age 55.3 ± 15.1 years; 28.9% female) were adapted cars (78.2%) and manual wheelchairs (69.9%). Provision of various devices markedly varied with age and SCI severity (e.g. 34.6% of those aged 76+ had a walking frame compared to 3.1% of those aged 31-45; 50.0% of participants with complete tetraplegia had a power wheelchair compared to 7.6% of those with complete paraplegia). Many devices were mostly used daily (e.g. manual wheelchair) while others were mostly used less frequently (e.g. handbikes). Unmet need was highest for arm braces (53.2% of those in need) and power assisted wheelchairs (47.3%), and lowest for crutches (11.4%) and manual wheelchairs (4.8%).

CONCLUSION

The devices individuals have or use is largely dependent on their age and SCI severity. While most participants have access to basic mobility devices, there is still a considerable degree of unmet need for certain devices.

Effect of Three Different Grip Angles on Physiological Parameters During Laboratory Handcycling Test in Able-Bodied Participants

INTRODUCTION

Handcycling is a relatively new wheelchair sport that has gained increased popularity for people with lower limb disabilities. The aim of this study was to examine the effect of three different grip positions on physical parameters during handcycling in a laboratory setting.

METHODS

Twenty one able-bodied participants performed three maximum incremental handcycling tests until exhaustion, each with a different grip angle. The angle between the grip and the crank was randomly set at 90° (horizontal), 0° (vertical), or 10° (diagonal). The initial load was 20 W and increased by 20 W each 5 min. In addition, participants performed a 20 s maximum effort.

RESULTS

The relative peak functional performance (W/kg), peak heart rate (bpm), associated lactate concentrations (mmol/l) and peak oxygen uptake per kilogram body weight (ml.min(-1).kg(-1)) for the different grip positions during the stage test were: (a) Horizontal: 1.43 ± 0.21 W/kg, 170.14 ± 12.81 bpm, 9.54 ± 1.93 mmol/l, 30.86 ± 4.57 ml/kg; (b) Vertical: 1.38 ± 0.20 W/kg, 171.81 ± 13.87 bpm, 9.91 ± 2.29 mmol/l, 29.75 ± 5.13 ml/kg; (c) Diagonal: 1.40 ± 0.22 W/kg, 169.19 ± 13.31 bpm, 9.34 ± 2.36 mmol/l, 29.39 ± 4.70 ml/kg. Statistically significant (p < 0.05) differences could only be found for lactate concentration between the vertical grip position and the other grips during submaximal handcycling.

CONCLUSION

The orientation of three different grip angles made no difference to the peak load achieved during an incremental handcycling test and a 20 s maximum effort. At submaximal load, higher lactate concentrations were found when the vertical grip position was used, suggesting that this position may be less efficient than the alternative diagonal or horizontal grip positions.