The effectiveness and satisfaction of web-based physiotherapy in people with spinal cord injury: a pilot randomised controlled trial.

STUDY DESIGN: A pilot randomised controlled trial. OBJECTIVES: The aims of this study were to evaluate the effectiveness and participant satisfaction of web-based physiotherapy in people with spinal cord injury (SCI). SETTING: Community patients of a national spinal injury unit in a university teaching hospital, Scotland, UK. METHODS: Twenty-four participants were recruited and randomised to receive 8 weeks of web-based physiotherapy (intervention), twice per week, or usual care (control). Individual exercise programmes were prescribed based on participants' abilities. The intervention was delivered via a website (www.webbasedphysio.com) and monitored and progressed remotely by the physiotherapist. RESULTS: Participants logged on to the website an average of 1.4±0.8 times per week. Between-group differences, although not significant, were more pronounced for the 6-min walk test. Participants were positive about using web-based physiotherapy and stated that they would be happy to use it again and would recommend it to others. Overall, it was rated as either good or excellent. CONCLUSIONS: Web-based physiotherapy was feasible and acceptable for people with SCI. Participants achieved good compliance with the intervention and rated the programme highly and beneficial for health and well-being at various states after injury. The results of this study warrant further work with a more homogeneous sample. SPONSORSHIP: This study was funded by the Queen Elizabeth National Spinal Injuries Unit, Glasgow, UK.

Development and validation of a physical activity monitor for use on a wheelchair.

STUDY DESIGN: Keeping physically active is important for people who mobilize using a wheelchair. However, current tools to measure physical activity in the wheelchair are either not validated or limited in their application. The purpose of this study was to develop and validate a monitoring system to measure wheelchair movement. METHODS: The system developed consisted of a tri-axial accelerometer placed on the wheel of a wheelchair and an analysis algorithm to interpret the acceleration signals. The two accelerometer outputs in the plane of the wheel were used to calculate the angle of the wheel. From this, outcome measures of wheel revolutions, absolute angle and duration of movement were derived and the direction of movement (forwards or backwards) could be distinguished. Concurrent validity was assessed in comparison with video analysis in 14 people with spinal cord injury using their wheelchair on an indoor track and outdoor wheelchair skills course. Validity was assessed using intraclass correlation coefficients (ICC(2,1)) and Bland-Altman plots. RESULTS: The monitoring system demonstrated excellent validity for wheel revolutions, absolute angle and duration of movement (ICC(2,1)>0.999, 0.999, 0.981, respectively) in both manual and powered wheelchairs, when the wheelchair was propelled forwards and backwards, and for movements of various durations. CONCLUSION: This study has found this monitoring system to be an accurate and objective tool for measuring detailed information on wheelchair movement and maneuvering regardless of the propulsion technique, direction and speed.

Objective assessment of mobility of the spinal cord injured in a free-living environment.

STUDY DESIGN: An exploratory study of the practicality and feasibility of an instrument. OBJECTIVES: To adapt an activity monitor for use on a wheelchair to assess long-term mobility in a free-living environment in the spinal cord injury (SCI) population, and to explore the utility of the data collected. SETTING: Glasgow, UK. METHODS: An activity monitor was adapted for use on a wheelchair wheel. The monitor was used to assess, for 1 week, the wheelchair mobility of seven participants with SCI who only used a wheelchair. In conjunction with a second monitor on the thigh the mobility of seven participants with SCI who used a wheelchair and upright mobility, and five healthy non-wheelchair users, were assessed for 1 day. RESULTS: The adapted monitor collected 1260 h of data and was suitable for use on both manual and electric wheelchairs. During 1 week, participants with SCI who only used a wheelchair spent between 4 and 13 h moving in the wheelchair, covering a distance of between 7 and 28 km. Distinct differences in mobility were shown between participants with an SCI and non-wheelchair users. The differences in time spent in mobility activities between the groups of participants with SCI were smaller. CONCLUSIONS: The system was successfully used in this group of participants with SCI, and could provide useful information on the mobility of people with SCI in a free-living environment.