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
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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
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during physical therapy (PT) and occupational therapy
(OT) is negligible [7], despite these being the most
active times of the day according to (...truncated)