Are adults with spinal cord injury meeting the spinal cord injury-specific physical activity guidelines? A look at a sample from a Canadian province.

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.

Development of the International Spinal Cord Injury Activities and Participation Basic Data Set.

STUDY DESIGN: Consensus decision-making process. OBJECTIVES: The objective of this study was to develop an International Spinal Cord Injury (SCI) Activities and Participation (A&P) Basic Data Set. SETTING: International working group. METHODS: A committee of experts was established to select and define A&P data elements to be included in this data set. A draft data set was developed and posted on the International Spinal Cord Society (ISCoS) and American Spinal Injury Association websites and was also disseminated among appropriate organizations for review. Suggested revisions were considered, and a final version of the A&P Data Set was completed. RESULTS: Consensus was reached to define A&P and to incorporate both performance and satisfaction ratings. Items that were considered core to each A&P domain were selected from two existing questionnaires. Four items measuring activities were selected from the Spinal Cord Independence Measure III to provide basic data on task execution in activities of daily living. Eight items were selected from the Craig Handicap Assessment and Reporting Technique to provide basic data on the frequency of participation. An additional rating of satisfaction on a three-point scale for each item completes the total of 24 A&P variables. CONCLUSION: Collection of the International SCI A&P Basic Data Set variables in all future research on SCI outcomes is advised to facilitate comparison of results across published studies from around the world. Additional standardised instruments to assess activities of daily living or participation can be administered, depending on the purpose of a particular study.

Relationships between wheelchair skills, wheelchair mobility and level of injury in individuals with spinal cord injury.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To describe the manual wheelchair (MWC) skill profiles of experienced MWC users with spinal cord injury and their wheeled mobility (distance and speed) while considering their level of injury and age. SETTING: Rehabilitation centers, participant's home and the community. METHODS: MWC skills were evaluated using the wheelchair skills test (WST) and wheeled mobility data were collected in the participants' own environment over a 7-day period, using a Cateye cycle computer (VELO 8). A total of 54 participants took part in the study. RESULTS: The mean total performance score of the sample on the WST was 80.7±11.8%, with a significant difference between participants with tetraplegia (C4-C8) and those with low-level paraplegia (T7-L2) (P<0.01). The average daily distance covered was 2.5±2.1 km at 1.7±0.9 km h(-1), with no significant difference between participants with paraplegia and those with tetraplegia (wheeled distance: P=0.70; speed: P=0.65). Significant relationships were found between MWC skills and daily wheeled distance (r=-0.32, P<0.05), but the correlation between these variables did not remain significant when controlling for age (partial r=0.26, P=0.07). CONCLUSION: These results suggest that the level of injury is related to MWC skills but not wheeled mobility. MWC skills are related to greater wheeled distance, but to a lesser extent when controlling for age.

International Spinal Cord Injury Quality of Life Basic Data Set.

STUDY DESIGN: Survey of expert opinion, feedback, and development of final consensus. OBJECTIVE: Present the background, purpose, development process and results for the International Spinal Cord Injury (SCI) Quality of Life (QoL) Basic Data Set. SETTING: International. METHODS: A committee of experts was established to select and define data elements to be included in an International SCI QoL Basic Data Set. A draft data set was developed and disseminated to appropriate organizations for comment. All suggested revisions were considered, and a final version of the QoL data set was completed. RESULTS: The QoL data set consists of 3 variables: ratings of satisfaction with general quality of life, satisfaction with physical health, and satisfaction with psychological health. All variables are rated on a scale ranging from 0 (completely dissatisfied) to 10 (completely satisfied). CONCLUSION: Collection of the International SCI QoL Basic Data Set variables should be a part of all future studies of SCI QoL to facilitate comparison of results across published studies from around the world. Additional standardized instruments to assess other aspects of QoL can be administered based on the purpose of a particular study.

The relationship between and predictors of quality of life after spinal cord injury at 3 and 15 months after discharge.

STUDY DESIGN: Longitudinal study. OBJECTIVES: To examine the relationship between and predictors of quality of life (QOL) at 3 and 15 months post-rehabilitation discharge using the Disability Creation Process model as an explanatory framework. SETTING: Vancouver, Canada. METHODS: A consecutive sample of individuals with spinal cord injury (SCI) was enrolled in the study. Data were collected using the Quality of Life Index (QLI) and a variety of personal, participation and environmental instruments. On admission, 197 subjects were recruited, but dropouts and missing values led to the final inclusion of 93 cases in multiple regression models used to identify predictors of QOL at 3 and 15 months post-rehabilitation discharge. RESULTS: Mean QLI group scores did not differ between 3 and 15 months (P = 0.85). Regression models accounted for 64% of variance in QLI total scores at 3 months and 70% of variance at 15 months. The main predictors of QOL at 3 months were health competence and mood state. The main predictors of QOL at 15 months were QOL level at 3 months, health competence and family support. At both time points, personal factors explained most of the variance, whereas participation and environmental factors were less significant. CONCLUSION: Given that health competence, mood state and some environmental factors may be amenable to modification, this study suggests interventions to mediate these variables might improve subjective QOL after SCI.

A review of instruments assessing participation in persons with spinal cord injury.

STUDY DESIGN: A systematic search of the literature. OBJECTIVES: To critically review instruments that assess participation in persons with spinal cord injury (SCI). SETTING: Vancouver, British Columbia. METHODS: Four electronic databases (MEDLINE/PubMed, CINAHL, EMBASE and PsychInfo) were searched for studies published between 1980 and March 2008. Instruments were included if information was published in English in at least one peer-reviewed journal on its measurement properties (reliability, validity and responsiveness) in a sample that included adults with SCI. Instruments were evaluated using criteria proposed for disability outcome measures. RESULTS: Six instruments were included: Craig Handicap Assessment and Reporting Technique (CHART); Impact on Participation and Autonomy Questionnaire (IPA); Assessment of Life Habits Scale (Life-H); Occupational Performance History Interview; Physical Activity Recall Assessment for People with Spinal Cord Injury; and Reintegration to Normal Living Index. Evidence supporting the reliability of the instruments was reported for four of the six instruments and was adequate. Validity was assessed in all the instruments. Only the Life-H and CHART have been compared with each other. No evidence on responsiveness was available. CONCLUSION: The instruments differ in how participation is operationalized. Currently, the CHART that measures objective aspects of participation has the most evidence supporting its measurement properties. More evidence is becoming available for instruments such as the IPA, which consider the person's perspective. It is important to determine what information about participation is required before selecting an instrument.

Effects on plasma lipoproteins and endogenous sex hormones of substituting lean white fish for other animal-protein sources in diets of postmenopausal women.

A crossover 8-wk study was conducted to compare the effects on plasma lipoproteins and endogenous sex hormones of lean white fish (LWF) and of beef, pork, egg, and milk (BPEM) within a prudent diet in postmenopausal women. Diets provided 8050 kJ as 19% proteins, 52% carbohydrates, 29% lipids (P/M/S (proportion of polyunsaturated, monounsaturated, and saturated fatty acids, 1.1:1:1) and approximately 210 mg cholesterol/d. The LWF diet compared with the BPEM diet significantly induced higher concentrations of plasma cholesterol, LDL-apo B, HDL-C, and HDL3-C, indicating that incorporation of LWF as a substitute for BPEM in a low-fat, high-P:S diet offers little benefit with regard to plasma cholesterol and LDL-apoB in postmenopausal women. Moreover, the LWF diet significantly increased plasma SHBG, suggesting that the divergent effects of substituting LWF for other animal-protein sources on plasma cholesterol and lipoproteins may be partly mediated by variations in plasma sex-hormone status.

Feasibility of an eight-week dance-based exercise program and its effects on locomotor ability of persons with functional class III rheumatoid arthritis.

OBJECTIVES: The main objectives of this experimental case series were to evaluate the feasibility of a modified dance-based exercise program with low ground impacts in persons with rheumatoid arthritis (RA) functional class III and to describe its effects on locomotor ability. The relationship between 3 locomotor tests and their responsiveness also were addressed. METHODS: Ten female subjects participated in an 8-week exercise program. Locomotor ability was measured before and after the program using the 50-foot test of walking time, the 6-minute test of walking distance, and the locomotion biomechanical analysis. RESULTS: All subjects showed a high compliance (92.5% presence at sessions) over the 8 weeks of exercise without any aggravation in disease status. They were able to train efficiently at moderate intensity up to 25 minutes. Significant improvements were found in locomotor ability, with a higher responsiveness measured by the locomotion biomechanical analysis, followed by the 6-minute gait test and the 50-foot gait test. Inconsistent relationships between tests suggested that different locomotor abilities are required during tests. CONCLUSION: These results support the feasibility of a modified dance-based exercise program for persons with severe RA. With high levels of responsiveness, the detailed biomechanical analysis and the 6-minute gait test are recommended for the assessment of locomotor ability.

Spinal cord injury, exercise and quality of life.

The ultimate goal of comprehensive rehabilitation in individuals with spinal cord injury (SCI) has shifted over time from an extension of their life expectancy to attainment of an optimal level of independent living and quality of life. After World War II, the important influence of sport and exercise upon the course of rehabilitation following SCI was recognised. Nonetheless, 5 decades later, there remains a lack of understanding of how an exercise programme can contribute to an improvement of quality of life among individuals with SCI. In future, attention should be directed toward avoidance of secondary impairments, disabilities and handicaps. The World Health Organization model of disablement provides a suitable framework for addressing this issue. The most common benefits of exercise are biological in nature. They target a reduction in secondary impairments (loss of cardiorespiratory, and muscular function, metabolic alterations and systemic dysfunctions). This in turn could minimise the development of disabilities and the appearance of such handicaps as loss of mobility, physical dependence and poor social integration. A lack of physical fitness for specific tasks can be a serious obstacle to autonomy following SCI. In a very short period of time, physical deconditioning can significantly decrease quality of life in individuals with SCI, ultimately placing them in a state of complete dependency. Quality of life is closely associated with independent living and, increasingly, it is a key outcome when measuring the success of rehabilitation. Consequently, research designs that examine the impact of exercise upon individuals with disabilities should not only include objective outcome measures, but also subjective measures relating to life-satisfaction and quality of life.

Biomechanical analysis of swing-through gait in paraplegic and non-disabled individuals.

The purpose of this study was to determine if the deficit of motor function affects the displacement of the lower limbs and increases the physical strain of upper-body musculature in paraplegic individuals performing swing-through gait. A biomechanical model consisting of four linked rigid bodies was developed to analyze this type of gait. Data were obtained on the spatio-temporal characteristics, kinematics and kinetics from a sample of eight non-disabled and nine paraplegic individuals performing swing-through gait. Net muscle moments acting on the segments and mechanical powers at three joints (shoulder, elbow, hip) were estimated during a complete gait cycle from basic force equations and moments of force acting on a rigid body. Results show that the two groups selected a similar comfortable speed suggesting that the type of gait per se is an important factor in the selection of speed. Paraplegic individuals had a longer crutch stance phase duration than the non-disabled due to inadequate hip muscle activations as confirmed by the moment of force and power analyses. Moreover, a higher moment of force at the shoulder was observed in the paraplegics individuals, mostly during the crutch stance phase. Consequently, the loss of motor function of the lower limbs in paraplegic individuals modifies the biomechanical pattern of swing-through gait compared to non-disabled individuals, and seems to increase the physiological demand on the upper limbs during the stance and swing phases of the gait cycle.

Association between characteristics of locomotion and accomplishment of life habits in children with cerebral palsy.

BACKGROUND AND PURPOSE: "Handicap situation" is defined in the literature as "a disruption in the accomplishment of a person's life habits (activities of daily living and social roles)." The purpose of this study was to determine the strength of association between various types of locomotion and the accomplishment of life habits, which is an indicator of the occurrence of handicap situations in children with cerebral palsy. SUBJECTS: Ninety-eight children with cerebral palsy, aged 5 to 17.8 years (mean = 10.5, SD = 3.5), were recruited. METHODS: The Life Habits Assessment was used to evaluate handicap situations in activities of daily living and social roles. Types of locomotion, the Pediatric Functional Independence Measure (locomotion section), and 2 tests representing functional activities (walking speed and stair climbing) were used as characteristics of locomotion. RESULTS: Locomotion capabilities were associated with the accomplishment of activities of daily living and social roles. Performance in variables related to locomotion, number of associated problems, and type of cerebral palsy explained 17% to 74% of the total variance in accomplishment of life habits in children who walked without technical aids. CONCLUSION AND DISCUSSION: The results suggest that locomotion might influence the accomplishment of life habits. Other factors, however--such as environmental barriers--should also be examined to determine their impact on the occurrence of handicap situations.

[Aging and technology: physical condition in a post-industrial society]. / Vieillissement et technologie: la condition physique dans une société post-industrialisée.

Compulsory retirement, normally set at 65, may be considered discriminatory by people who wish to continue in their current employment to a greater age. The aging process sometimes limits the performance of daily work, particularly in occupations that demand a high rate of energy expenditure. However, this is not a general rule; there are many individuals older than 65 years (particularly those who have remained physically active) who can still carry out moderate physical tasks without fatigue. This article reviews various aspects of occupation, including the evaluation of work performance, and the beneficial effects of programs designed to increase functional capacity in the context of compulsory retirement. Biological age seems a useful criterion in deciding upon the appropriateness of mandatory retirement when reviewing individual cases. The authors recommend adopting a form of health hazard appraisal and measures of physical condition (including aerobic power, muscular strength and reaction time) as a part of such an evaluation, while recognizing the need for more precise methods of identifying those who can remain in gainful employment beyond the age of 65 years.

Long-term consequences of spinal cord injury on social participation: the occurrence of handicap situations.

PURPOSE: Handicap situations in daily life of persons with Spinal Cord Injury (SCI) is rarely evaluated in spite of their impact on long-term health. The purpose of the present study was to identify the occurrence of potential handicap situations in individuals with SCI and to determine the potential associations between the level of social participation and some characteristics of the person. METHODS: Four hundred and eighty-two individuals completed a mailed questionnaire that comprised the 'assessment of life habits', a tool developed to assess social participation in persons with disabilities. RESULTS: Significant disruptions were particularly observed in home maintenance, participation in recreational and physical activities as well as in productive activities and the achievement of sexual relations. However, many individuals successfully achieved various social roles despite the presence of disabilities. No indications of a potential impact of premature ageing on the accomplishment of life habits were observed. CONCLUSIONS: The severity of injury seems to significantly increase the occurrence of handicap situations as the individuals with tetraplegia reported carrying out their life habits with much more difficulty or requiring more assistance than those with a less severe impairment.

Association between personal and environmental factors and the occurrence of handicap situations following a stroke.

BACKGROUND AND PURPOSE: Little is known about the potential role of environmental factors in the handicap creation process following a stroke. The objective of this study was to explore the presence of a relationship between environmental factors and the occurrence of handicap following a stroke, taking into consideration age and the level of impairments and disabilities. METHODS: This is a cross-sectional study where data were collected 6 months after discharge from an intensive functional rehabilitation unit. A convenience sample of 51 participants was recruited at the time of their admission to the rehabilitation unit for rehabilitation post-stroke. Perceived influence of environmental factors was measured using the Measure of the Quality of the Environment (MQE). Handicap situations were measured with the Assessment of Life Habits (LIFE-H). Impairments and disabilities comprised six domains (cognition, perception. depression, communication, sensorimotor function and comorbidity) assessed using a variety of measuring tools from which a composite score was derived. RESULTS: Fifty-one participants aged 40-97 years old took part in this study. Perceived obstacles in the environment, together with age and the level of impairments and disabilities, explained 58.9% of the variation in the LIFE-H (handicap level). Taken alone, the perceived obstacles (total score) explained 6.2%. The perceived facilitators (total score) in the environment were not found to be related to the presence of handicap situations. CONCLUSION: Increased level of impairments and disabilities. advanced age and perceived barriers in the physical and social environment contribute to the handicap creation process following a stroke.

Predictors of handicap situations following post-stroke rehabilitation.

PURPOSE: Many stroke survivors have to cope with impairments and disabilities that may result in the occurrence of handicap situations. The purpose of the study was to explore bio-psycho-social predictors of handicap situations six months after discharge from an intensive rehabilitation programme. METHODS: At discharge from a rehabilitation programme, participants were evaluated with instruments measuring motor, sensory, cognitive, perceptual, affective and psychosocial impairments and disabilities that may play a role in the development of handicap. Some other demographic and clinical variables, and those related to rehabilitation, were also collected. Six months later, they were re-assessed in their own environment in order to document their handicap level with the Assessment of Life Habits (LIFE-H). RESULTS: One hundred and thirty-two stroke patients participated in the discharge evaluation and 102 of them also participated in the handicap measurement. Relationships between handicap level and impairments and disabilities were all statistically significant. Multiple regression analyses indicated that affect, lower extremity co-ordination, length of stay in rehabilitation, balance, age and comorbidity at the end of an intensive rehabilitation programme are the best predictors of handicap situations six months later (adjusted R(2): 68.1%). CONCLUSIONS: In spite of its exploratory nature, this study revealed that, among a substantial number of personal characteristics, some were more related to a handicap measure and have greater predictive value. Other studies should be carried out to validate these findings and to consider more environmental factors in order to better understand factors related to the development of handicap situations.

Guarding against pitfalls in multivariate analysis. An illustration from fitness testing of the spinally-injured.

Potential pitfalls in the multivariate analysis of data, and methods of overcoming such problems, are illustrated by reference to recent research that has examined relationships between fitness variables and overall productivity in a population of young male paraplegics. Particular attention is directed to the need for residual analysis, tests of multiple collinearity, and a cautious approach to interpreting the theoretical meaning of individual coefficients in multiple regression equations.

Body mass index as a discriminant function among health-related variables and risk factors.

A group of 206 subjects (30-55 years) were studied with the objective of quantifying the relationships between fitness indicators (relative body weight (BMI), aerobic power, muscular endurance), health indicators and risk factors, (appraised age, cost of health services consumed, blood pressure (SBP and DBP), blood lipids (CHO and HDL), cigarette smoking). BMI was significantly correlated with the risk indicators in the male sample (.302 less than or equal to r less than or equal to .364) and in the female sample (.217 less than or equal to r less than or equal to .521). All coefficients were in the direction of the established biological assumption as concerns hazards to health. The discriminant analysis revealed that in the total group of men, 77% (p less than or equal to .001) of the subjects could be classified either in high or low BMI (greater than Q75 or less than or equal to Q25) on the basis of the scores in SBP, HDL, HDL/CHO. In the subgroup of women greater than or equal to 40 years, statistically significant classification occurred in 100% of the cases (p less than or equal to .001) on the basis of DBP, CHO, HDL/CHO, NCIG. The results indicate that BMI is a fitness determinant which is valid, convenient and easy to use in the detection of unfavorable health indices and when clinical intervention is justified.

Relationship of impairment and functional ability to habitual activity and fitness following spinal cord injury.

Associations between a physically active leisure, physical fitness, impairment and disability have been tested in 123 volunteers (73 with paraplegia and 50 with quadriplegia). Active physical leisure was assessed by the questionnaire of Godin and Shephard (Canadian Journal of Sports Sciences 10, 141-6 1985). Fitness measures included body mass index, peak oxygen intake on a wheelchair ergometer, and tests of muscle strength and endurance (peak isokinetic torque, average muscle power and total muscle work for shoulder flexion, shoulder adduction and elbow flexion at movement speeds of 60 degrees and 180 degrees s-1). Primary impairment was assessed by the ISMGF scale, and secondary impairment was judged from reported pressure scores, spasticity, and urinary infections over the previous 12 months. Scores for self-care and mobility were obtained using a modified Barthel Index. Physically active leisure and fitness were unrelated to secondary impairment. However, functional ability for a given primary impairment was significantly correlated with peak oxygen intake and the three indices of muscle strength, particularly in individuals with high level lesions. Associations between physical activity and functional ability were weaker, but tended in the same direction. Although longitudinal studies are needed to prove the causality of these relationships, the findings point towards a significant influence of fitness status upon functional ability. Rehabilitation teams should thus give a stronger emphasis to systematic exercise conditioning programmes when planning overall treatment following SCI.

Social consequences of long term impairments and disabilities: conceptual approach and assessment of handicap.

OBJECTIVES: To present a conceptual model of disablement adapted from the WHO model and to conduct a pilot study with a measurement tool (LIFE-H) of the concepts of life habits and handicap situations. DESIGN: Content validity and test-retest reliability study. SETTING: General community. PARTICIPANTS: A panel of 12 experts of rehabilitation for the process of content validity and 49 individuals with spinal cord disorders (adults and children) for the reliability study. OUTCOMES MEASURES: a person's life habits (activities of daily living and social roles). RESULTS: The LIFE-H questionnaire was designed to assess the handicap situations observed in daily life of individuals with disability. The experts concluded that the LIFE-H items covered most of a person's life habits (ADL and social roles) and that it could be used to determine the appearance of handicap situations. The LIFE-H total score showed a good level of reliability for the children and the adult samples (ICC = 0.73 and 0.74, respectively). Taken individually, a majority of life habit categories have shown a moderate to high reliability level (ICC > or = 0.50) while a few life habit categories such as the interpersonal relationship or nutrition showed a lower reliability level. CONCLUSION: The development of LIFE-H allows fulfillment of the need to determine the disruptions in life habits of persons with disabilities.

Participation and Well-Being Among Older Adults Living with Chronic Conditions.

This study explored the unique contribution of participation (daily activities and social roles) in explaining well-being of older adults living with chronic conditions and examined which aspect of participation (accomplishment of participation or satisfaction with participation) was more important in describing their well-being. Two hundred older adults with chronic conditions completed the following assessments: Satisfaction with Life Scale to measure well-being; Assessment of Life Habits to evaluate two aspects of participation: (a) accomplishment of daily activities and social roles and (b) level of satisfaction with participation; Interpersonal Support Evaluation List to assess level of social support and Affect Balance scale to measure level of balance confidence. In addition, participants' level of mobility was assessed using the Timed Up and Go test. Regression analysis was performed. Results indicated that number of chronic conditions, social support and satisfaction with participation had a significant contribution to well-being and altogether explained 31% of its variance whereas accomplishment of participation did not play as significant role in the model. In conclusion, participation has a unique contribution to older adults' well-being where satisfaction with participation rather than the accomplishment of activities is of importance. Additional aspects of participation and level of disability are key factors identified for further inquiry.