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1.

Objective

To assess (1) if fitness and mobility are related to behavior and perception of physical barriers and (2) if behavior and physical barrier perception are related.

Design

Cross-sectional case series.

Setting

Academic Medical Laboratory.

Participants

Manual wheelchair users (N=50) with chronic spinal cord injury (62% paraplegia).

Intervention

None.

Main Outcome Measures

Participants completed the following assessments: (1) fitness: graded exercise test (aerobic) and Wingate (anaerobic); (2) mobility: 6-minute push test and 30-second sprint test; (3) physical barrier behavior: Encounters of Environmental Features in the Environmental Aspects of Mobility Questionnaire (EAMQ); (4) physical barrier perception: Craig Hospital Inventory of Environmental Factor (CHIEF) Environmental Barriers domain.

Results

Individuals with paraplegia had higher fitness, mobility, and environmental barrier encounter rates and lower avoidance per encounter rates vs tetraplegia (all P≤.05). For individuals with tetraplegia only, as mobility and fitness increased, frequencies of (1) encounters increased; (2) avoidances per encounter decreased, in multiple EAMQ domains (all P≤.05). Perception of barriers did not differ between lesion levels (P=.79). Mobility and fitness were not related to environmental barriers perception in both groups (all P>.17).

Conclusions

Fitness and mobility are associated with barrier behaviors (ie, encounters and avoidances) among individuals with tetraplegia, but not paraplegia. Despite a greater barrier avoidance rate, persons with tetraplegia do not perceive more physical barriers than persons with paraplegia. Surprisingly, fitness and mobility were not related to perception of barriers in either group. More research is required on if barrier perception, behavior, or both influence participation, to enable rehabilitation programs to tailor interventions to enhance participation.  相似文献   

2.

Objective

This study examined aerobic capacity, upper leg muscular strength, and static postural control as correlates of the energetic cost of walking (Cw) in moderate multiple sclerosis (MS) mobility disability.

Design

Cross-sectional study.

Setting

University-based laboratory.

Participants

Persons (N=44) with MS (aged 48.43±8.64 years) who have reached a benchmark of moderate mobility disability (ie, Expanded Disability Status Scale scores between 4.0 and 6.0) participated in the study.

Main Outcome Measures

Cw was based on (1) net oxygen consumption collected using a portable metabolic unit and (2) walking speed during the 6-minute walk test. Participants underwent standard assessments of peak aerobic capacity, upper leg muscular strength, and static postural control.

Results

The data were analyzed using bivariate correlation and linear regression analyses. Cw was inversely correlated with peak oxygen consumption (r=–.308, P<.05), peak power output (r=–.548, P<.00), and peak torque at 75° knee flexion (r=–.340, P<.05), whereas Cw was positively correlated center of pressure area sway (r=.319, P<.05), and mediolateral sway velocity (r=.411, P<.05). 40.3% of variance in Cw was explained by peak power output (β=–.526, P<.01) and mediolateral sway velocity (β=.339, P<.05).

Conclusion

Our findings demonstrate that aerobic power and postural sway may be important correlates of Cw in moderate MS mobility disability. Peak power output reflects a person’s physiological functional reserve that is directly relevant for understanding the penalty of walking impairment on the energetic demands of walking. The association between mediolateral postural sway and Cw suggests that mechanical inefficiency controlling the trajectory of the body’s center of pressure during ambulation may contribute to the elevated Cw.  相似文献   

3.

Objective

To examine the ability of the Spinal Cord Injury-Functional Index/Assistive Technology (SCI-FI/AT) measure to detect change in persons with spinal cord injury (SCI).

Design

Multisite longitudinal (12-mo follow-up) study.

Setting

Nine SCI Model Systems programs.

Participants

Adults (N=165) with SCI enrolled in the SCI Model Systems database.

Interventions

Not applicable.

Main Outcome Measures

SCI-FI/AT computerized adaptive test (CAT) (Basic Mobility, Self-Care, Fine Motor Function, Wheelchair Mobility, and/or Ambulation domains) completed at discharge from rehabilitation and 12 months after SCI. For each domain, effect size estimates and 95% confidence intervals were calculated for subgroups with paraplegia and tetraplegia.

Results

The demographic characteristics of the sample were as follows: 46% (n=76) individuals with paraplegia, 76% (n=125) male participants, 57% (n=94) used a manual wheelchair, 38% (n=63) used a power wheelchair, 30% (n=50) were ambulatory. For individuals with paraplegia, the Basic Mobility, Self-Care, and Ambulation domains of the SCI-FI/AT detected a significantly large amount of change; in contrast, the Fine Motor Function and Wheelchair Mobility domains detected only a small amount of change. For those with tetraplegia, the Basic Mobility, Fine Motor Function, and Self-Care domains detected a small amount of change whereas the Ambulation item domain detected a medium amount of change. The Wheelchair Mobility domain for people with tetraplegia was the only SCI-FI/AT domain that did not detect significant change.

Conclusions

SCI-FI/AT CAT item banks detected an increase in function from discharge to 12 months after SCI. The effect size estimates for the SCI-FI/AT CAT vary by domain and level of lesion. Findings support the use of the SCI-FI/AT CAT in the population with SCI and highlight the importance of multidimensional functional measures.  相似文献   

4.

Objective

To evaluate whether virtual reality games (VRGs) in stroke survivors produce significant and reproducible heart rate and oxygen consumption (V˙o2) responses during their execution, corresponding to an intensity between the anaerobic threshold (AT) and the respiratory compensation point (RCP).

Design

Single-subject, repeated-measure design.

Setting

Stroke survivors registered from a rehabilitation program.

Participants

Chronic hemiparetic stroke survivors (N=12; 10 men; mean age ± SD, 58±12y) rated at 3 or 4 in the Functional Ambulation Categories.

Interventions

Participants underwent, in a random order, 2 identical sessions of VRGs (console Xbox 360 + Kinect) and 1 control session (38min watching a movie). The VRG sessions were composed of 4 sets of VRGs (3min of tennis, 1min for changing the game, and 4min of boxing) interspaced with 2 minutes of rest.

Main Outcome Measures

Heart rate and V˙o2 were measured during the experimental sessions and compared with heart rate and V˙o2 obtained at AT and RCP assessed during a maximal cardiopulmonary exercise test.

Results

Heart rate and V˙o2 during VRGs had good reproducibility (intraclass correlation coefficients, ≥.91 and ≥.85, respectively; coefficients of variation, ≤6.7% and ≤13.7%, respectively). Heart rate during VRGs was similar to AT and significantly lower than RCP (P≤.05), while V˙o2 was significantly lower than AT and RCP (P<.05).

Conclusions

An acute session of VRGs composed of tennis and boxing games using the console XBox 360 + Kinect promotes reproducible responses of heart rate and V˙o2 that corresponded, respectively, to AT and below AT, characterizing a low-intensity aerobic stimulus.  相似文献   

5.

Objective

To determine whether a powered ankle-foot orthosis (AFO) that provides dorsiflexor and plantar flexor assistance at the ankle can improve walking endurance of persons with multiple sclerosis (MS).

Design

Short-term intervention.

Setting

University research laboratory.

Participants

Participants (N=16) with a neurologist-confirmed diagnosis of MS and daily use of a prescribed custom unilateral passive AFO.

Interventions

Three 6-minute walk tests (6MWTs), 1 per footwear condition: shoes (no AFO), prescribed passive AFO, and portable powered AFO (PPAFO). Assistive devices were worn on the impaired limb.

Main Outcome Measures

Distance walked and metabolic cost of transport were recorded during each 6MWT and compared between footwear conditions.

Results

Each participant completed all three 6MWTs within the experimental design. PPAFO use resulted in a shorter 6MWT distance than did a passive AFO or shoe use. No differences were observed in metabolic cost of transport between footwear conditions.

Conclusions

The current embodiment of this PPAFO did not improve endurance walking performance during the 6MWT in a sample of participants with gait impairment due to MS. Further research is required to determine whether expanded training or modified design of this powered orthosis can be effective in improving endurance walking performance in persons with gait impairment due to MS.  相似文献   

6.

Objective

To describe functioning in people living with spinal cord injuries (SCI) in Switzerland.

Design

Secondary analysis of cross-sectional survey data.

Setting

Community, Switzerland.

Participants

Individuals (N=1549) 16 years of age or older with a history of traumatic or nontraumatic SCI and permanently residing in Switzerland.

Interventions

Not applicable.

Main Outcome Measures

Functioning was operationalized through 4 domains: (1) impairments in body functions; (2) impairments in mental functions; (3) independence in performing activities; and (4) performance problems in participation.

Results

Univariate analysis indicated a high prevalence of problems in 5 areas: (1) housework; (2) climbing stairs; (3) tiredness; (4) spasticity; and (5) chronic pain. Graphical modeling showed a strong association among the four domains of functioning. Moreover, we found that the differences in the dependence structures were significant between the paraplegia SCI population and the tetraplegia SCI population.

Conclusions

This study is a first study in the epidemiology of functioning of people living with SCI in Switzerland. Using univariate and graphical modeling approaches, we proposed an empirical foundation for developing hypotheses on functioning in each domain and category that could inform health systems on people’s health needs.  相似文献   

7.

Objective

To evaluate the effects of pressure threshold respiratory training (RT) on heart rate variability and baroreflex sensitivity in persons with chronic spinal cord injury (SCI).

Design

Before-after intervention case-controlled clinical study.

Setting

SCI research center and outpatient rehabilitation unit.

Participants

Participants (N=44) consisted of persons with chronic SCI ranging from C2 to T11 who participated in RT (n=24), and untrained control subjects with chronic SCI ranging from C2 to T9 (n=20).

Interventions

A total of 21±2 RT sessions performed 5 days a week during a 4-week period using a combination of pressure threshold inspiratory and expiratory devices.

Main Outcome Measures

Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and beat-to-beat arterial blood pressure and heart rate changes during the 5-second-long maximum expiratory pressure maneuver (5s MEP) and the sit-up orthostatic stress test, acquired before and after the RT program.

Results

In contrast to the untrained controls, individuals in the RT group experienced significantly increased FVC and FEV1 (both P<.01) in association with improved quality of sleep, cough, and speech. Sympathetically (phase II) and parasympathetically (phase IV) mediated baroreflex sensitivity both significantly (P<.05) increased during the 5s MEP. During the orthostatic stress test, improved autonomic control over heart rate was associated with significantly increased sympathetic and parasympathetic modulation (low- and high-frequency change: P<.01 and P<.05, respectively).

Conclusions

Inspiratory-expiratory pressure threshold RT is a promising technique to positively affect both respiratory and cardiovascular dysregulation observed in persons with chronic SCI.  相似文献   

8.

Objective

To compare cardiorespiratory responses between pool floor walking and overground walking (OW) in people poststroke.

Design

Cross-sectional study.

Setting

University-based therapeutic exercise facility.

Participants

Participants (N=28) were comprised of 14 community-dwelling individuals poststroke (5.57±3.57y poststroke) and 14 age- and sex-matched healthy adults (mean age, 58.00±15.51y; male/female ratio, 9:5).

Interventions

Not applicable.

Main Outcome Measures

A telemetric metabolic system was used to collect cardiorespiratory variables, including oxygen consumption (V˙o2), energy expenditure (EE), and expired volume per unit time (V˙e), during 6-minute walking sessions in chest-depth water and on land at a matched speed, determined by average of maximum walking speed in water.

Results

Individuals poststroke elicited no significant differences in cardiorespiratory responses between pool floor walking and OW. However, healthy controls showed significant increases in mean V˙o2 values by 94%, EE values by 109%, and V˙e values by 94% (all P<.05) during pool floor walking compared with OW. A 2×2 mixed model analysis of variance revealed a significant group × condition interaction in V˙o2, in which the control group increased V˙o2 from OW to pool floor walking, whereas the stroke group did not.

Conclusions

Our results indicate that people poststroke, unlike healthy adults, do not increase EE while walking in water compared with on land. Unlike stationary walking on an aquatic treadmill, forward locomotion during pool floor walking at faster speeds may have increased drag force, which requires greater EE from healthy adults. Without demanding excessive EE, walking in water may offer a naturally supportive environment for gait training in the early stages of rehabilitation.  相似文献   

9.

Background

Increase in visceral adipose tissue (VAT) is an independent risk for mortality and other health-related comorbidities.

Objective

To examine the gender differences in VAT and subcutaneous adipose tissue (SAT) cross-sectional areas (CSA) between men and women with chronic spinal cord injury (SCI). The differences in the distribution of central adiposity were used to determine the association of VAT and SAT to metabolic dysfunction after SCI.

Design

Cross-sectional design.

Setting

Hospital-based study.

Participants

Sixteen individuals (8 men and 8 women) with motor complete SCI were matched based on age, time since injury, and level of injury.

Methods

Anthropometrics, dual x-ray absorptiometry (DXA), and magnetic resonance imaging were captured to measure lean mass, fat mass (FM), percentage FM, VAT, and SAT CSAs. Basal metabolic rate was measured, and intravenous glucose tolerance test and lipid panel were performed.

Main Outcome Measurements

VAT, SAT, and metabolic profile.

Results

SAT CSA was 1.6 -1.75 times greater in the upper and lower trunks in women compared to men with SCI (P < .05). VAT CSA was 1.8-2.6 times greater in the upper and lower trunks in men compared to women with SCI (P < .05). VAT adjusted to body weight was greater in men compared to women with SCI. High-density lipoprotein cholesterol (HDL-C) was positively related to SAT and negatively related to VAT. Glucose effectiveness was negatively related to lower trunk SAT (r = ?0.60, P = .02). HDL-C ratio and triglycerides were positively related to upper VAT, lower VAT, and VAT:SAT ratio.

Conclusion

Magnetic resonance imaging demonstrated that there is a gender dimorphism in central adiposity in persons with chronic SCI. This gender dimorphism in central adipose tissue distribution may explain the higher prevalence of metabolic dysfunction in men with SCI, especially, the decrease in the HDL-C profile.

Level of Evidence

IV  相似文献   

10.

Objective

To assess the influence of a home-based exercise intervention on indices of health-related quality of life (HRQOL) in persons with spinal cord injury (SCI).

Design

This was a randomized controlled trial (HOMEX-SCI; ISRCTN57096451). After baseline laboratory testing and a week of free-living physical activity monitoring, eligible participants were randomly assigned (2:1 allocation ratio) to a home-based moderate-intensity upper-body exercise intervention group (INT, n=13), or a lifestyle maintenance control group (CON, n=8), for 6 weeks.

Setting

Home-based with short laboratory visits immediately before and after the intervention/control period.

Participants

Inactive participants (N=21) with chronic (>1yr) SCI (injury level <T4).

Intervention

Participants assigned to the INT completed 4, 45-minute moderate-intensity (60%-65% peak oxygen uptake) arm-crank exercise sessions per week for 6 weeks. Participants assigned to the control group (CON) were asked to maintain their habitual physical activity behavior.

Main Outcome Measures

Secondary outcome measures were assessed, including physical and mental component scores (PCS and MCS) of health-related quality of life (HRQOL), fatigue, global fatigue (FSS), and shoulder pain index (WUSPI). Cardiorespiratory fitness (CRF), objectively measured habitual moderate-to-vigorous physical activity (MVPA), and exercise self-efficacy (ESE) were also assessed at baseline and follow-up.

Results

Changes in the PCS (P=.017) of the Short Form 36 Health Survey (SF-36), ESE (P=.011), and FSS (P=.036) were significantly different between the 2 groups, with moderate to large effect sizes (d=0.75-1.37). Various HRQOL outcomes demonstrated likely to very likely positive inferences in favor of the INT group following the 6-week exercise intervention. Changes in ESE were significantly (P<.01) associated with changes in PCS (r=0.62), MCS (r=0.71), FSS (r=-0.71), and global fatigue (r=0.57).

Conclusions

A 6-week upper-body exercise intervention improved indices of HRQOL in persons with SCI. Improvements were associated with increases in ESE. While this intervention demonstrated a positive effect on perceived physical functioning, future interventions should aim to support social and mental functioning and exercise maintenance.  相似文献   

11.

Background

Spinal cord injury (SCI) results in increased accumulation of visceral adipose tissue (VAT). Anthropometrics may provide an alternative to estimate VAT cross-section area (CSA) compared to magnetic resonance imaging (MRI).

Objective

To validate the use of anthropometrics, including abdominal circumference and skinfold thickness (SFT) measurements against MRI to predict subcutaneous adipose tissue (SAT) and VAT cross-sectional areas in persons with SCI.

Design

Cross-sectional.

Setting

Clinical research center

Participant

Twenty-two men with motor complete SCI

Methods

Anthropometric measurements and MRI were taken during a single visit. Abdominal circumference and SFT were used to derive prediction equations for subcutaneous adipose tissue (SATAnthro-CSA) and VAT (VATAnthro-CSA). Three-axial MRI at the level of umbilicus was used to establish the prediction equations. VATAnthro-CSA was compared against body mass index (BMI), waist circumference, and SFT. Bland-Altman plots were used to determine limits of agreement between prediction equations and MRI.

Main Outcome Measurements

SAT and VAT cross-sectional areas.

Results

SATAnthro-CSA explained 76% of the variance in SAT cross-sectional area (r2 = 0.76, standard error of the estimate [SEE] = 49.5 cm2, P <.001). VATAnthro-CSA explained 72% of VAT cross-sectional area (r2 = 0.72, SEE = 45.8 cm2, P <.001). Compared to VATAnthro-CSA, BMI, waist circumference, and SFT explained only 37%, 63%, and 31%, respectively, in the variance of VAT MRI.

Conclusion

Abdominal circumference and SFT demonstrated an alternative way to predict VAT CSA. VATAnthro-CSA estimated VATMRI more accurately than BMI, waist circumference, and SFT in individuals with chronic SCI.

Level of Evidence

I  相似文献   

12.

Objective

To evaluate the effect of quadriceps functional electrical stimulation (FES)-cycling on exertional oxygen uptake (V˙o2) compared with placebo FES-cycling in patients with chronic obstructive pulmonary disease (COPD).

Design

A randomized, single-blind, placebo-controlled crossover trial.

Setting

Pulmonary rehabilitation department.

Participants

Consecutive patients (N=23) with COPD Global Initiative for Chronic Obstructive Lung Disease stage 2, 3, or 4 (mean forced expiratory volume during the first second, 1.4±0.4L [50.3% predicted]) who had recently begun a respiratory rehabilitation program.

Intervention

Two consecutive 30-minute sessions were carried out at a constant load with active and placebo FES-cycling.

Main Outcome Measures

The primary outcome was mean V˙o2 during the 30-minute exercise session. The secondary outcomes were respiratory gas exchange and hemodynamic parameters averaged over the 30-minute endurance session. Lactate values, dyspnea, and perceived muscle fatigue were evaluated at the end of the sessions.

Results

FES-cycling increased the physiological response more than the placebo, with a greater V˙o2 achieved of 36.6mL/min (95% confidence interval [CI], 8.9–64.3mL/min) (P=.01). There was also a greater increase in lactate after FES-cycling (+1.5mmol/L [95% CI, .05–2.9mmol/L]; P=.01). FES-cycling did not change dyspnea or muscle fatigue compared with the placebo condition.

Conclusions

FES-cycling effectively increased exercise intensity in patients with COPD. Further studies should evaluate longer-term FES-cycling rehabilitation programs.  相似文献   

13.

Objectives

To investigate the impact that the presence of chronic low back pain with radiculopathy (CLBPR) may have on (1) energy efficiency and (2) energy capacity among community-dwelling older adults.

Design

Matched case-control study.

Setting

Clinical research laboratory.

Participants

Included in the analysis were community-dwelling older adults (N=38, 60-85 years) with and without CLBPR. Participants were matched between-groups on age (±5 years), sex, and diabetic status.

Interventions

Not applicable.

Main Outcome Measures

Energy cost of walking at self-selected speed (ie, energy efficiency) and peak volume of oxygen consumed (ie, energy capacity).

Results

Older adults with CLBPR had a higher energy cost of walking at self-selected speed (P=.009) and lower peak volume of oxygen consumed while walking (P=.050), compared to those without pain.

Conclusions

Older adults with CLBPR may benefit from specific rehabilitative interventions that target these potentially modifiable energetic outcomes, thereby reducing the risk of mobility decline. Future studies should identify which mechanisms specifically contribute to diminished energy efficiency and capacity among older adults with CLBPR.  相似文献   

14.

Objective

To examine the safety and efficacy of using a clitoral vacuum suction device (CVSD) versus vibratory stimulation (V) to treat orgasmic dysfunction in women with multiple sclerosis (MS) or spinal cord injury (SCI).

Design

Randomized clinical trial.

Setting

Two academic medical centers.

Participants

Women (N=31) including 20 with MS and 11 with SCI.

Intervention

A 12-week trial of the use of a CVSD versus V.

Main Outcome Measures

Female Sexual Function Inventory (FSFI) and Female Sexual Distress Scale (FSDS).

Results

Twenty-three women (18 MS, 5 SCI) completed the study including 13 of 16 randomized to CVSD and 10 of 15 randomized to V. There was a statistically significant increase in total FSFI score (P=.011), desire (P=.009), arousal (P=.009), lubrication (P=.008), orgasm (P=.012), and satisfaction (P=.049), and a significant decrease in distress as measured by FSDS (P=.020) in subjects using the CVSD. In subjects who used V, there was a statistically significant increase in the orgasm subscale of the FSFI (P=.028). Subjects using the CVSD maintained improvements 4 weeks after treatment.

Conclusions

CVSD is safe and overall efficacious to treat female neurogenic sexual dysfunction related to MS and SCI. V is also safe and efficacious for female neurogenic orgasmic dysfunction; however, results were limited to the active treatment period. Because of ease of access and cost, clinicians can consider use of V for women with MS or SCI with orgasmic dysfunction. CVSD is recommended for women with multiple sexual dysfunctions or for whom V is ineffective.  相似文献   

15.

Background

Adipose tissue produces leptin, which is pro-inflammatory, and adiponectin, which has anti-inflammatory properties. Participants with chronic spinal cord injury (SCI) have increased body fat and are at increased risk for respiratory illness.

Objective

To assess the associations between leptin and adiponectin with pulmonary function in a chronic SCI cohort.

Design

Cross-sectional study.

Setting

Veterans Affairs Medical Center.

Participants

A total of 285 participants (237 men and 48 women) with chronic SCI with mean (standard deviation) injury duration 17.8 (13.2) years from the VA Boston and the community participating in an epidemiologic study assessing factors associated with respiratory health.

Methods

Participants (24.6% cervical American Spinal Injury Association Impairment Scale (AIS) level A, B, and C; 33.6% other AIS A, B, and C; 41.8% AIS D) provided a blood sample, completed a respiratory health questionnaire, and underwent spirometry. Linear regression methods were used to assess cross-sectional associations between plasma leptin and adiponectin with spirometric measures of pulmonary function adjusted for age, race, gender, and height. Level and severity of SCI, mobility mode, body mass index, smoking, chronic obstructive pulmonary disease, asthma, chest injury history, laboratory batch, and other potential confounders were also considered.

Main Outcome Measurements

forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC.

Results

There was a statistically significant inverse relationship between plasma leptin assessed in quartiles or as a continuous covariate with FEV1 and FVC. In fully adjusted models, each interquartile range (16,214 pg/mL) increase in leptin was associated with a significant decrease in FEV1 (?93.1 mL; 95% confidence interval = ?166.2, ?20.0) and decrease in FVC (?130.7 mL; 95% confidence interval = ?219.4, ?42.0). There were no significant associations between leptin and FEV1/FVC or between plasma adiponectin with FEV1, FVC, or FEV1/FVC.

Conclusion

Plasma leptin in individuals with chronic SCI is inversely associated with FEV1 and FVC, independently of SCI level and severity and other covariates. This finding suggests that plasma leptin may contribute to reduced pulmonary function in chronic SCI.

Level of Evidence

II  相似文献   

16.

Background

Pressure ulcers (PUs) are a common and severe health condition in persons with spinal cord injury (SCI). Skin-care strategies for PU prevention are usually provided during initial rehabilitation. However, individuals with SCI often do not perform these strategies continuously, especially after discharge. The influence of psychological factors such as general self-efficacy (GSE) on the performance of PU prevention behavior has not yet been sufficiently explored.

Objective

To investigate whether persons with greater levels of GSE are more likely to perform skin-care strategies for PU prevention regularly.

Design

Nationwide cross-sectional survey within the Swiss Spinal Cord Injury Cohort Study.

Setting

Community setting, data collection between 2011 and 2013.

Participants

A total of 456 subjects with a traumatic or nontraumatic SCI living in Switzerland.

Methods

Associations between GSE and PU prevention behavior were analyzed by multivariate proportional odds regression models, including potential sociodemographic, lesion-related, and lifestyle-related confounders without and with interaction terms between GSE and potential effect modifiers.

Main Outcome Measurements

Self-efficacy was assessed by the GSE scale comprising 10 items. PU preventive behavior was operationalized using 5 items of an adapted version of the Spinal Cord Injury Lifestyle scale. Both measurements were components of a self-administered questionnaire.

Results

Based on the regression model without interaction terms, GSE levels were not associated with skin-care PU prevention. After we included interaction terms, the final model showed statistically significant associations between GSE and 3 skin-care items with odds ratios ranging from 1.09 to 1.17 (all P < .001). The slightly positive effect of GSE on PU prevention behavior was restricted to persons who sustained their SCI at a younger age.

Conclusions

GSE was generally not associated with skin-care PU prevention behavior among persons with SCI in this study. In further research, it might be of interest to assess SCI-specific concepts of self-efficacy.

Level of Evidence

III  相似文献   

17.

Objective

To assess the additional effect of a home-based neuromuscular electrical stimulation (NMES) program as an add-on to pulmonary rehabilitation (PR), on functional capacity in subjects with chronic obstructive pulmonary disease (COPD).

Design

Single-blind, multicenter randomized trial.

Setting

Three PR centers.

Participants

Subjects with severe to very severe COPD (N=73; median forced expiratory volume in 1 second, 1L (25th–75th percentile, 0.8–1.4L) referred for PR. Twenty-two subjects discontinued the study, but only 1 dropout was related to the intervention (leg discomfort).

Intervention

Subjects were randomly assigned to either PR plus quadricipital home-based NMES (35Hz, 30min, 5 time per week) or PR without NMES for 8 weeks.

Main Outcome Measure

The 6-minute walk test (6MWT) was used to assess functional capacity.

Results

Eighty-two percent of the scheduled NMES sessions were performed. In the whole sample, there were significant increases in the distance walked during the 6MWT (P<.01), peak oxygen consumption (P=.02), maximal workload (P<.01), modified Medical Research Council dyspnea scale (P<.01), and Saint George’s Respiratory Questionnaire total score (P=.01). There was no significant difference in the magnitude of change for any outcome between groups.

Conclusions

Home-based NMES as an add-on to PR did not result in further improvements in subjects with severe to very severe COPD; moreover, it may have been a burden for some patients.  相似文献   

18.

Objective

To compare metabolic, cardiorespiratory, and perceptual responses to acute eccentric and traditional concentric arm cycling in a cohort of wheelchair users.

Design

Single-group repeated measures.

Setting

Exercise physiology laboratory.

Participants

A convenience sample of 7 manual wheelchair users (45±15 y; 87±21 kg; 1.8±0.1 m; time in wheelchair 17±14 y) volunteered.

Interventions

Participants performed 5-minute trials of eccentric and concentric arm cycling at (1) isometabolic rate (35% of peak oxygen consumption) and (2) isopower output (80W). Exercise trials were performed on an eccentric/concentric arm cycle ergometer that integrated with a personal wheelchair.

Main Outcome Measures

Primary measures included power output, oxygen consumption, heart rate, ventilation, blood lactate, and perceived exertion. Secondary measures assessed included perceived muscle soreness, likability, frequency of use, and duration of use.

Results

At isometabolic rate, power production during eccentric arm cycling was ～3× greater than concentric arm cycling (80±36 vs 26±10 W; P<.01). When exercising at isopower output, oxygen consumption during eccentric arm cycling was ～1/2 that of concentric arm cycling (0.66±0.15 vs 1.30±0.65 L/min; P=.03). Heart rate and perceived exertion were also substantially lower during eccentric arm cycling (both P<.05). Muscle soreness assessed 24-72 hours postexercise was minimal (<1.0 cm). Preference scores and anticipated frequency and duration of use did not differ between eccentric arm cycling and concentric arm cycling (all P>.05).

Conclusion

Eccentric arm cycling provided a metabolically efficient (high-force, low-energy cost) and usable (wheelchair accessible, safe, likable) exercise for wheelchair users. Implementation of eccentric arm cycling with this population is promising but additional research is needed to confirm this possibility.  相似文献   

19.

Objectives

To investigate the role of spinal cord injury (SCI) peer mentorship on quality of life (QoL)/participation, and test a self-determination theory model that explains the role of SCI peer mentorship on these outcomes.

Design

A static group comparison design.

Setting

Community.

Participants

A convenience sample of mentees (individuals receiving peer mentorship) (n=68) and nonmentees (n=63) who had an SCI, were older than 18 years, and spoke either English or French.

Interventions

Mentees: at least 4 peer mentorship sessions over the past 5 years; nonpeer mentees: 0 or 1 brief introductory session.

Main Outcome Measures

QoL (ie, life satisfaction and positive and negative affect), participation (eg, autonomous indoor; family role), and the psychological needs of autonomy, competence, and relatedness.

Results

No group differences were found, but years since injury was a moderator indicating that, generally, peer mentees living with SCI for longer (～30y) appear to benefit more from peer mentorship interactions compared with nonmentees and mentees living with SCI for approximately 6 years. Competence and relatedness mediated the peer mentorship–outcome relationship for QoL and some participation variables, indicating that peer mentorship predicted competence and relatedness, which in turn were related to the outcomes.

Conclusions

Satisfaction of competence and relatedness needs requires greater attention in SCI peer mentorship. Years since injury modified the relationship between peer mentorship and outcomes, which provided new insights on the role of SCI peer mentorship. Further studies are needed to determine SCI peer mentorship–specific outcomes that are important across the years-since-injury spectrum.  相似文献   

20.

Objective

To quantify the effects of initial hip angle and angular hip velocity settings of a lower-limb wearable robotic exoskeleton (WRE) on the balance control and mechanical energy requirements in patients with paraplegic spinal cord injuries (SCIs) during WRE-assisted sit-to-stand (STS).

Design

Observational, cross-sectional study.

Setting

A university hospital gait laboratory with an 8-camera motion analysis system, 3 forceplates, a pair of instrumented crutches, and a WRE.

Participants

Patients (N=12) with paraplegic SCI.

Interventions

Not applicable.

Main Outcome Measures

The inclination angle (IA) of the body’s center of mass (COM) relative to the center of pressure (COP), and the rate of change of IA (RCIA) for balance control, and the mechanical energy and forward COM momentum before and after seat-off for energetics during WRE-assisted STS were compared between conditions with 2 initial hip angles (105° and 115°) and 3 initial hip angular velocities (800, 1000, 1200 rpm).

Results

No interactions between the main factors (ie, initial hip angle vs angular velocity) were found for any of the calculated variables. Greater initial hip angle helped the patients with SCI move the body forward with increased COM momentum but reduced RCIA (P<.05). With increasing initial angular hip velocity, the IA and RCIA after seat-off (P<.05) increased linearly while total mechanical energy reduced linearly (P<.05).

Conclusions

The current results suggest that a greater initial hip angle with smaller initial angular velocity may provide a favorable compromise between momentum transfer and balance of the body for people with SCI during WRE-assisted STS. The current data will be helpful for improving the design and clinical use of the WRE.  相似文献   

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