Objective and Self-Reported Physical Activity Measures and Their Association With Depression and Satisfaction With Life in Persons With Spinal Cord Injury.

OBJECTIVE: To identify associations between objective and self-reported measures of physical activity (PA) and relationships with depression and satisfaction with life (SWL) in persons with spinal cord injury (SCI). DESIGN: Retrospective, cross-sectional study of objectively measured wheelchair propulsion (WCP) from 2 studies in which an odometer was attached to participants' wheelchairs to record daily speed and distance. Self-reported data were collected in a separate study examining dyspnea, PA, mood, and SWL. SETTING: Outpatient clinic in a rehabilitation center. PARTICIPANTS: Individuals (N=86) with traumatic SCI who use a manual wheelchair. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Objective measures of PA included average daily distance and speed of WCP measured by an odometer. Self-report questionnaires included demographics, the 24-hour recall of transfers, Physical Activity Recall Assessment for People with SCI, the Patient Health Questionnaire-2 (PHQ-2) to document depressive symptoms, and the Satisfaction With Life Scale (SWLS). RESULTS: Both objective measures of WCP, average daily distance and speed, were predicted by the combination of self-reported daily time away from home/yard and lower frequency of car transfers ([r=.367, P=.002] and [r=.434, P<.001], respectively). Daily distance of WCP was negatively correlated with depression (PHQ-2) (r=-.309, P=.004). Time in leisure PA was the only significant predictor of SWLS scores (r=.321, P=.003). CONCLUSIONS: Short-term recall of hours away from home/yard not spent driving or riding in a vehicle is suggested as a self-report measure that is moderately related to overall WCP PA in this population. Results of this study suggest that depression is related to decreased PA and WCP activity, while SWL is related to leisure PA.

Shoulder Pain Prevention Program for Manual Wheelchair Users With Paraplegia: A Randomized Clinical Trial.

Objectives: To compare prevalence of shoulder pain (SP) onset over 3 years for individuals with paraplegia from spinal cord injury who participate in one of two shoulder pain prevention program (SPPP) formats with that of a similar population without intervention, and to compare exercise adherence between two SPPP formats. Methods: The randomized clinical trial (compared to historical controls) included a volunteer sample of 100 individuals without SP at study entry. Eighty-seven participants returned for assessments at 18 and 36 months after study entry. Control group included 220 volunteers from a 3-year observational study with identical inclusion criteria. SPPPs included shoulder home exercises and recommendations to improve mobility techniques that are effective in reducing existing SP in this population. Participants were randomly assigned to receive either one instruction session and a refresher session 4 weeks later with a physical therapist or a 4-week series of 2-hour group classes taught by a physical therapist and peer mentor. Prevalence of SP onset at 18 and 36 months and self-reported average weekly exercise frequency were the main outcome measures. Results: SP onset was identical in the two SPPPs but was significantly lower at 18 and 36 months in both groups (11% and 24%) compared to controls (27% and 40%, p < .05). Self-reported average weekly exercise frequency was similar between intervention groups but was significantly lower during the first 4 months in participants who developed SP compared to those without pain (2.12 ± 1.0 vs. 3.01 ± 1.13, p < .05). Conclusion: SPPPs reduced SP onset prevalence regardless of instruction format. Exercise adherence was important to the outcome of shoulder pain.

Shoulder Strength and Physical Activity Predictors of Shoulder Pain in People With Paraplegia From Spinal Injury: Prospective Cohort Study.

BACKGROUND: Shoulder joint pain is a frequent secondary complaint for people following spinal cord injury (SCI). OBJECTIVE: The purpose of this study was to determine predictors of shoulder joint pain in people with paraplegia. METHODS/DESIGN: A 3-year longitudinal study was conducted. Participants were people with paraplegia who used a manual wheelchair for at least 50% of their mobility and were asymptomatic for shoulder pain at study entry. Participants were classified as having developed shoulder pain if they experienced an increase of ≥10 points on the Wheelchair User's Shoulder Pain Index in the 3-year follow-up period. Measurements of maximal isometric shoulder torques were collected at study entry (baseline), 18 months, and 3 years. Daily activity was measured using a wheelchair odometer, and self-reported daily transfer and raise frequency data were collected by telephone every 6 weeks. RESULTS: Two hundred twenty-three participants were enrolled in the study; 39.8% developed shoulder pain over the 3-year follow-up period. Demographic variables and higher activity levels were not associated with shoulder pain onset. Baseline maximal isometric torque (normalized by body weight) in all shoulder muscle groups was 10% to 15% lower in participants who developed shoulder pain compared with those who remained pain-free. Lower shoulder adduction torque was a significant predictor of shoulder pain development (log-likelihood test=11.38), but the model explained only 7.5% of shoulder pain onset and consequently is of limited clinical utility. LIMITATIONS: Time since SCI varied widely among participants, and transfer and raise activity was measured by participant recall. CONCLUSIONS: Participants who developed shoulder pain had decreased muscle strength, particularly in the shoulder adductors, and lower levels of physical activity prior to the onset of shoulder pain. Neither factor was a strong predictor of shoulder pain onset.

Impact of Gender on Shoulder Torque and Manual Wheelchair Usage for Individuals with Paraplegia: A Preliminary Report.

BACKGROUND: The prevalence of women with spinal cord injury is increasing, and their unique attributes merit attention, specifically, shoulder strength and community wheelchair propulsion. RESULTS: Shoulder torques were 62%-96% greater in men than women, average daily distance traveled was greater for men, and average speeds were similar. CONCLUSIONS: Community wheelchair propulsion speed was similar between men and women but men were significantly stronger, therefore daily mobility requires a higher relative effort for women's shoulder muscles. This demand may increase susceptibility to fatigue and development of shoulder pain.