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Correlates of physical activity in ambulatory people with spinal cord injury during the first year after inpatient rehabilitation

Spinal Cord (2024)Cite this article

Subjects

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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Fig. 1: Graphical presentation of the interaction between fear of falling and level of mobility.

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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.

Author information

Authors and Affiliations

  1. Rijndam Rehabilitation, Rotterdam, The Netherlands

    Karin Postma & Rutger Osterthun

  2. Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands

    Karin Postma, Rita J. G. van den Berg-Emons & Rutger Osterthun

  3. Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands

    Tijn van Diemen

  4. Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Centre Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands

    Marcel W. M. Post & Janneke M. Stolwijk-Swüste

  5. University of Groningen, University Medical Centre Groningen, Centre for Rehabilitation, Groningen, The Netherlands

    Marcel W. M. Post

  6. Department of Spinal Cord Injury and Orthopedics, De Hoogstraat Rehabilitation, Utrecht, The Netherlands

    Janneke M. Stolwijk-Swüste

Authors
  1. Karin Postma
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Contributions

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.

Corresponding author

Correspondence to Karin Postma.

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Competing interests

The authors declare no competing interests.

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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