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

Dominik Zbogar,Andrei V Krassioukov,William C Miller,Janice J Eng,Mary C Verrier

doi:10.1186/s12984-016-0208-8

Abstract

BackgroundLittle 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.MethodsIn 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.ResultsThere 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).ConclusionPhysical 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.

Highlights

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 the subcomponents of time spent outside of physical therapy (PT) and occupational therapy (OT) sessions reveals that ~50% of all time was spent engaged in leisure time sedentary activity
The fact that individuals are doing more physical activity without any major perception of this suggests that individuals have the capacity to increase their levels of physical activity over the inpatient stay

Summary

Introduction

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. 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. 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. As time in therapy makes up only a small proportion of a patient’s day, it is important to develop an understanding of physical activity levels outside of rehabilitation therapy sessions in order to put time spent in PT and OT in context as well as assess the overall daily physical activity that the patient is experiencing. While some studies have evaluated therapy intensity or content during structured therapy [6, 9,10,11,12,13,14] this study is unique in that it captures physical activity outside of structured rehabilitation sessions and does so using both a self-report interview and a real-time, objective measure (accelerometry)

Methods

Results

Conclusion