Physical activity outside of structured therapy during inpatient spinal cord injury rehabilitation

Journal of NeuroEngineering and Rehabilitation, Nov 2016

Background Little information exists on the content of inpatient rehabilitation stay when individuals with spinal cord injury (SCI) are not engaged in structured rehabilitation therapy sessions. Investigation of inpatient therapy content is incomplete without the context of activities outside of this time. We sought to quantify physical activity occurring outside of physical therapy (PT) and occupational therapy (OT) sessions during inpatient SCI rehabilitation and examine how this activity changes over time from admission to discharge. Methods In this longitudinal observational study at two inpatient SCI rehabilitation centres, 95 participants were recruited through consecutive admissions. Physical activity at admission and discharge was recorded by 1) self-report (PARA-SCI questionnaire) and 2) real-time accelerometers worn on the dominant wrist, and hip if ambulatory. For analyses, we separated participants into those with paraplegia or tetraplegia, and a subgroup of those ambulatory at discharge. Wilcoxon signed rank tests (admission vs. discharge) were used for PARA-SCI minutes and accelerometry activity kilocounts. Results There was no change in self-report physical activity, where the majority of time was spent in leisure time sedentary activity (~4 h) and leisure time physical activity at a higher intensity had a median value of 0 min. In contrast, significant increases in physical activity outside PT and OT sessions from admission to discharge were found for wrist accelerometers for individuals with tetraplegia (i.e., upper limb activity) and hip accelerometers for ambulatory individuals (i.e., walking activity). Conclusion Physical activity is low in the inpatient SCI rehabilitation setting outside of structured therapy with a substantial amount of time spent in leisure time sedentary activity. Individuals appear to have the capacity to increase their levels of physical activity over the inpatient stay.

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Physical activity outside of structured therapy during inpatient spinal cord injury rehabilitation

Zbogar et al. Journal of NeuroEngineering and Rehabilitation Physical activity outside of structured therapy during inpatient spinal cord injury rehabilitation Dominik Zbogar 0 1 2 Janice J. Eng 0 1 2 William C. Miller 0 1 6 Andrei V. Krassioukov 0 1 5 Mary C. Verrier 3 4 0 International Collaboration on Repair Discoveries , Vancouver , Canada 1 Rehabilitation Research Program, Vancouver Coastal Health Research Institute , 4255 Laurel Street, V5Z 2G9 Vancouver, BC , Canada 2 Department of Physical Therapy, Faculty of Medicine, University of British Columbia , Vancouver , Canada 3 Department of Physical Therapy, Faculty of Medicine, University of Toronto , Toronto , Canada 4 University Health Network-Toronto Rehabilitation Institute , Toronto , Canada 5 Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia , Vancouver , Canada 6 Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of British Columbia , Vancouver , Canada Background: Little information exists on the content of inpatient rehabilitation stay when individuals with spinal cord injury (SCI) are not engaged in structured rehabilitation therapy sessions. Investigation of inpatient therapy content is incomplete without the context of activities outside of this time. We sought to quantify physical activity occurring outside of physical therapy (PT) and occupational therapy (OT) sessions during inpatient SCI rehabilitation and examine how this activity changes over time from admission to discharge. Methods: In this longitudinal observational study at two inpatient SCI rehabilitation centres, 95 participants were recruited through consecutive admissions. Physical activity at admission and discharge was recorded by 1) selfreport (PARA-SCI questionnaire) and 2) real-time accelerometers worn on the dominant wrist, and hip if ambulatory. For analyses, we separated participants into those with paraplegia or tetraplegia, and a subgroup of those ambulatory at discharge. Wilcoxon signed rank tests (admission vs. discharge) were used for PARA-SCI minutes and accelerometry activity kilocounts. Results: There was no change in self-report physical activity, where the majority of time was spent in leisure time sedentary activity (~4 h) and leisure time physical activity at a higher intensity had a median value of 0 min. In contrast, significant increases in physical activity outside PT and OT sessions from admission to discharge were found for wrist accelerometers for individuals with tetraplegia (i.e., upper limb activity) and hip accelerometers for ambulatory individuals (i.e., walking activity). Conclusion: Physical activity is low in the inpatient SCI rehabilitation setting outside of structured therapy with a substantial amount of time spent in leisure time sedentary activity. Individuals appear to have the capacity to increase their levels of physical activity over the inpatient stay. PARA-SCI; Accelerometry; Physical activity; Spinal cord injury; Inpatient; Rehabilitation - Background Physical activity after a spinal cord injury (SCI) is important for optimizing recovery from SCI as well as the ability to improve secondary complications like physical deconditioning resulting from bed rest, cardiovascular disease and autonomic disorders [1]. Rehabilitation is effective in accelerating and promoting improvement in activities of daily living; indeed, a delay in starting appropriate and intensive activities may negatively influence a participant’s ultimate functional capability since the degree of post-SCI deconditioning will increase with a longer delay in starting an exercise program [2, 3]. There is some debate as to whether the level of physical activity during rehabilitation stay is adequate for optimizing neurological recovery or for achieving sufficient physical capacity for returning to the community [4, 5]. How much inpatient rehabilitation prepares individuals with SCI to engage in physical activity once they return home is unknown, though the significant decrease in physical activity that follows discharge [6] suggests preparation is not optimal. We have recently shown that the amount of cardiovascular stress experienced © The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. during physical therapy (PT) and occupational therapy (OT) is negligible [7], despite these being the most active times of the day according to (...truncated)


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Dominik Zbogar, Janice Eng, William Miller, Andrei Krassioukov, Mary Verrier. Physical activity outside of structured therapy during inpatient spinal cord injury rehabilitation, Journal of NeuroEngineering and Rehabilitation, 2016, pp. 99, 13, DOI: 10.1186/s12984-016-0208-8