Abstract
Study design
Longitudinal cohort study.
Objectives
Examine the longitudinal association between mobility and level of physical activity (PA) and explore which other factors are also associated with level of PA in ambulatory people with Spinal Cord Injury (SCI) during the first-year post-inpatient rehabilitation.
Setting
Three SCI-specialized rehabilitation centers and the Dutch community.
Methods
Forty-seven adults with recent SCI and ambulatory function were included. All had motor incomplete lesions, 49% had tetraplegia, and the mean age was 55 ± 13 years. Duration of accelerometry-based all-day PA and self-reported level of mobility, exertion of walking, pain, fatigue, depressive mood symptoms, fear of falling, exercise self-efficacy, and attitude toward PA were measured just before discharge from inpatient rehabilitation and 6 and 12 months after discharge. All data were longitudinally analyzed using generalized estimating equations analyses. Models were corrected for age, lesion level, and time since injury.
Results
Mobility was longitudinally associated with level of PA (beta: 4.5, P < 0.001, R2: 41%). In addition, lower levels of exertion of walking (beta: −5.6, P < 0.001), fear of falling (beta: −34.1, P < 0.001), and higher levels of exercise self-efficacy (beta: 2.3, P = 0.038) were associated with higher levels of PA. Exertion of walking and fear of falling were associated with level of PA independent of mobility.
Conclusions
Mobility, exertion of walking, fear of falling, and exercise self-efficacy seem to be correlates of level of PA in ambulatory people with SCI during the first year after inpatient rehabilitation. Targeting these factors using an interdisciplinary approach may enhance levels of PA in this population.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
The authors thank all participants and the participating rehabilitation centers for contributing to this study. In addition, we thank Herwin Horemans for developing the data processing algorithms and Inge Arts, Esther Groenewegen, Ellen Moons, Anne-Claire Nuijens, Eline Scholten, Chantal Hillebregt, Suzanne van den Oever, and Maxine de Jonge, for their contribution concerning patient inclusion and measurements.
Funding
Rijndam Rehabilitation financially supported this study. The study was an extension of the SELF-SCI study financed by The Dutch Rehabilitation Foundation (HandicapNL) grant number 2014039. The funders played no role in the study’s design, conduct, or reporting.
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All authors contributed substantially to the conception, design, and interpretation of data and participated in revising the article. Dr. Postma provided data collection and data analysis and drafted the article. Dr. van Diemen and Dr. Stolwijk were involved in the data collection. All authors gave final approval of the version to be published and agreed to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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Ethical approval
The Medical Ethical Committee of Erasmus MC (Rotterdam, the Netherlands) reviewed the study protocol (MEC-2016-072). It concluded that this study was not within the scope of the Dutch Medical Research Involving Human Subjects Act. The study conformed to the Declaration of Helsinki, and all participating rehabilitation centers approved the study. All participants provided informed consent before entering the study.
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Postma, K., van Diemen, T., Post, M.W.M. et al. Correlates of physical activity in ambulatory people with spinal cord injury during the first year after inpatient rehabilitation. Spinal Cord (2024). https://doi.org/10.1038/s41393-024-00982-x
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DOI: https://doi.org/10.1038/s41393-024-00982-x
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