ABSTRACT
BACKGROUND: Health, fitness and lifestyle professionals can play important roles in promoting physical activity in groups at risk of developing an inactive lifestyle, such as people with spinal cord injury (SCI). Tailored counselling is a promising tool to promote and improve physical activity levels. To support professionals to effectively have a conversation about physical activity with clients with SCI, evidence-based training and resources are needed. This project aimed to (1) co-develop an e-learning course on best practices for SCI physical activity counselling and, (2) examine the effectiveness and usability of this course. METHODS: Guided by the technology-enhanced learning (TEL) evaluation framework, we used a systematic, multistep approach to co-develop and evaluate an e-learning course. The development process was informed by input and feedback from a diverse group of end-users and experts (n > 160) via online surveys and (think-aloud) interviews. A randomized controlled trial was used to compare learning outcomes (post-knowledge and self-efficacy) between participants who completed the course (intervention group) and the wait-listed control group. Usability, learning experiences, and satisfaction were assessed among all participants. RESULTS: Forty-one participants (21 intervention-group; 20 control-group) with various backgrounds (e.g., lifestyle counsellors, physiotherapists, occupational therapists, recreation therapists, fitness trainers) enrolled in the randomized controlled trial. After completing the course, participants in the intervention group showed significantly improved knowledge on the best practices for SCI physical activity counselling and higher self-efficacy for using these best practices in conversations with clients with SCI compared to the control group (p <.001). Participants reported above average usability scores, positive learning experiences, and high levels of satisfaction when completing the course. CONCLUSION: We used a systematic, multi-step, theory-informed approach to co-develop and evaluate an evidence-based e-learning course on SCI physical activity counselling to support professionals to promote physical activity in their daily practices. The overall positive findings demonstrate that the e-learning course is feasible and ready for further implementation in various health and community settings. Implementation of the e-learning course can help professionals improve the physical activity support they provide to their clients, and subsequently increase physical activity participation in people with SCI.
Subject(s)
Computer-Assisted Instruction , Spinal Cord Injuries , Humans , Learning , Counseling , ExerciseABSTRACT
OBJECTIVES: This project used a systematic and integrated knowledge translation (IKT) approach to co-create theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury (SCI). METHODS: Guided by the IKT Guiding Principles, we meaningfully engaged research users throughout this project. A systematic approach was used. An international, multidisciplinary expert panel (n = 15), including SCI researchers, counselors, and people with SCI, was established. Panel members participated in two online meetings to discuss the best practices by drawing upon new knowledge regarding counselor-client interactions, current evidence, and members' own experiences. We used concepts from key literature on SCI-specific physical activity counseling and health behavior change theories. An external group of experts completed an online survey to test the clarity, usability and appropriateness of the best practices. RESULTS: The best practices document includes an introduction, the best practices, things to keep in mind, and a glossary. Best practices focused on how to deliver a conversation and what to discuss during a conversation. Examples include: build rapport, use a client-centred approach following the spirit of motivational interviewing, understand your client's physical activity barriers, and share the SCI physical activity guidelines. External experts (n = 25) rated the best practices on average as clear, useful, and appropriate. CONCLUSION: We present the first systematically co-developed theory- and evidence-based best practices for SCI physical activity counseling. The implementation of the best practices will be supported by developing training modules. These new best practices can contribute to optimizing SCI physical activity counseling services across settings.
ABSTRACT
STUDY DESIGN: Single-group pre-test post-test study. OBJECTIVES: Examine the change in (1) fitness and body composition due to self-guided training in preparation for the HandbikeBattle in people with spinal cord injury (SCI); and (2) whether these possible body composition changes are associated with changes in fitness. SETTING: Handcycling teams of Dutch rehabilitation centers training for the HandbikeBattle, a handcycling race on an Austrian mountain. METHODS: Fitness (peak power output (POpeak) determined during a graded handcycling exercise test) and body composition (body mass, body mass index (BMI), waist circumference (WC), %fat determined with skinfolds and fat and fat free mass (% and kg) assessed by bio-impedance analysis (BIA)) of 18 persons with SCI were evaluated before and after 4 months of training for the HandbikeBattle. The effects of training were evaluated with repeated measures ANOVA. Associations among changes in POpeak and changes in body composition were calculated with Pearson correlation coefficients. RESULTS: Training for the HandbikeBattle led to significant improvements in POpeak, fat mass measured by BIA (19.6 ± 9.6 kg to 18.5 ± 8.3 kg, p = 0.02), %fat measured by skinfolds (28.4 ± 7.8% to 27.2 ± 7.2%, p = 0.02), while body mass and WC approached significance (p = 0.06). Association among changes in body composition and changes in POpeak ranged from trivial (e.g., for %fat BIA r = -0.023) to moderate (e.g., for WC, r = -0.32). CONCLUSIONS: Self-guided training for the HandbikeBattle led to a large increase in fitness but had a small effect on body composition, e.g., nutrition may play a more important role than exercise.
ABSTRACT
BACKGROUND: Since physical activity and exercise levels are known to be generally low in persons with spinal cord injury (SCI), there seems to be a need for intervention. Exercise self-efficacy (ESE), the confidence persons have in their ability to be physically active and exercise, is an important and modifiable predictor of physical behavior. The goal of this study was to 1) describe ESE in persons with subacute SCI, 2) to assess ESE in subgroups based on demographic and lesion characteristics, and 3) to explore the relation between ESE and physical behavior and physical capacity. METHODS: Thirthy-seven persons with subacute SCI who are wheelchair dependent participated. Participants completed the Exercise Self-Efficacy Scale. We recorded age and lesion characteristics, measured physical behavior (physical activity, motility and sedentary day time, n = 35) with an accelerometer-based activity monitor and measured physical capacity (peak power output, n = 28 and peak oxygen uptake, n = 24) during a maximal hand-cycling test. Measurements were performed 2 months prior to discharge from inpatient rehabilitation. Mann-Whitney tests were used to test for differences between subgroups based on age and lesion characteristics and spearman correlations were used to assess the relation between ESE and physical activity and physical capacity. RESULTS: Persons with tetraplegia had lower ESE compared to persons with paraplegia (Z = -1.93, p = 0.05). No differences in ESE were found between subgroups based on age and motor completeness of the lesion. In persons with paraplegia, ESE was positively related to peak power output (ρ = 0.58, p = 0.02). The relation of ESE with wheeled physical activity was ρ = 0.36, p = 0.09. CONCLUSIONS: In persons with SCI who are dependent on a manual wheelchair, lesion level when categorized as paraplegic and tetraplegic affected ESE whereas age categories and completeness categories did not. Persons with tetraplegia were found to have lower confidence with regard to physical activity and exercise indicating that this subgroup can benefit from extra attention in the promotion of physical activity and exercise. In persons with paraplegia, ESE seemed to be lower in persons with less peak power output and less daily physical activity.
Subject(s)
Paraplegia/psychology , Personality , Quadriplegia/psychology , Spinal Cord Injuries/psychology , Spinal Cord Injuries/rehabilitation , Female , Humans , Inpatients , Male , Middle Aged , Paraplegia/etiology , Paraplegia/rehabilitation , Quadriplegia/etiology , Quadriplegia/rehabilitation , WheelchairsABSTRACT
Wheelchair users with spinal cord injury generally have a relatively inactive lifestyle. Several studies have shown that an inactive lifestyle is associated with a lower fitness level, poorer health, reduced social participation and a lower quality of life for wheelchair users. There are a number of ways in which wheelchair users can remain active in daily life, for instance, by using a wheelchair or handbike for mobility instead of taking the car, and by participating in sports or wheelchair sports. Some prerequisites should be met to enable wheelchair users to have a more active lifestyle: the wheelchair should be optimally adjusted and the everyday environment, including sport facilities, should be easily accessible. An active lifestyle often also requires a change in attitude or behaviour. General practitioners, other primary healthcare providers and rehabilitation professionals can help in this respect.
