Physical fitness in people with a spinal cord injury: the association with complications and duration of rehabilitation

Abstract

Objective: To assess the association between physical fitness and its recovery over time on the one hand, and complications and duration of phases of rehabilitation on the other. Design and setting: Prospective cohort study at eight rehabilitation centres. Subjects: People with a spinal cord injury were assessed four times: at the start of active rehabilitation (n ¼ 110), three months later (n ¼ 92), at discharge (n ¼ 137) and a year after discharge from inpatient rehabilitation (n ¼ 91). Main measures: Physical fitness was defined as aerobic capacity, determined at each occasion by the peak oxygen uptake (peak Vo 2 ; L/min) and the peak power output (peak PO; W) during a maximal exercise test. On these occasions, spasticity, musculoskeletal and neurogenic pain were determined (1 ¼ present; 0 ¼ absent). During inpatient rehabilitation, complications (urinary tract infection, pulmonary infection or pressure sore) and bed rest were registered (1 ¼ complication; 0 ¼ no complications, and 1 ¼ bed rest; 0 ¼ no bed rest). Complications and bed rest occurring during the year after discharge were registered similarly. Results: Multilevel random coefficient analyses revealed associations in multivariate models (P 0.05). The peak oxygen uptake was negatively associated with complications after discharge. The recovery of peak power output over time was negatively associated with bed rest and spasticity. Both physical fitness and its recovery were negatively associated with the duration of active rehabilitation. Conclusion: Results suggest that limiting complications, spasticity or bed rest may improve fitness. A longer duration of active rehabilitation is not associated with an increase in physical fitness.

Wheelchair-specific fitness of inactive people with long-term spinal cord injury

“…Systematic monitoring of wheelchair-specific fitness after inpatient rehabilitation could be part of such a model, since it can support the maintenance of fitness (1). Maintaining wheelchair-specific fitness in people with long-term ScI can help to support health, participation in society and quality of life (3)(4)(5)9). Monitoring can also help to target those in most need of interventions; this need may differ between inactive people with long-term ScI, as indicated by the high variance in fitness in our study.…”

“…An explanation for the group's highly variable fitness levels might be found in the group's variance in factors such as age, gender, body mass, physical activity levels, time since injury, lesion level and completeness (13), in addition to factors such as spinal deformities and history of secondary health complications (9). this remains a topic for future study, given the cross-sectional design and relatively small sample size in our study.…”

“…Physically inactive people with long-term ScI are a group that is specifically expected to suffer from low wheelchair-specific fitness (6). this group not only has an inactive lifestyle that has been associated with lower wheelchair-specific fitness (7), but also has a relatively high incidence of secondary health complications that can lead to reduced wheelchair-specific fitness (8)(9)(10).…”

An audit of the physiotherapy management of paraplegic patients with sacral pressure sores

“…Spasticity interferes with functioning in patients leading to further reduction in activity (Hasima et al 2007). This decrease in the level of mobility is then a factor which contributes to the worsening or development of further pressure sores (Gelis et al 2009;Rodriquez and Garber 1994;Bryne and Salzberg 1996).…”

Prognostic Models for Physical Capacity at Discharge and 1 Year Postdischarge From Rehabilitation in Persons With Spinal Cord Injury

“…38 VO 2 peak is related to organ function and is therefore more influenced by complications. 39 Respiratory function was less predictable because of several possible reasons.…”