Woude, L.H.V. van der

Prospective analysis of body mass index during and up to 5 years after discharge from inpatient spinal cord injury rehabilitation (Article)

2010-11-01T00:00:00Z

Objective: To investigate the prevalence of overweight/obesity and the course of the body mass index (BMI) in persons with spinal cord injury during and after inpatient rehabilitation. Design: Multi-centre longitudinal study. Subjects: A total of 184 persons with spinal cord injury. Methods: BMI was determined at the start of active rehabilitation, 3 months later, at discharge, and 1, 2 and 5 years after discharge. Results: The percentage of persons who were overweight/obese (BMI ≤22 kg/m2) increased over the years from 56% to 75%. The absolute BMI did not significantly increase during rehabilitation, but showed a significant increase the year after discharge from inpatient rehabilitation (p<0.001). From examining the personal or lesion characteristics, age was the only factor that was related to the absolute BMI. BMI increased by 1 kg/m2for each 10-year increase in age. Men, persons with paraplegia and older people had more chance of being overweight/obese compared with women, persons with tetraplegia and younger people. Conclusion: The BMI of people with spinal cord injuries gradually increases during and after inpatient rehabilitation, with significant increases in the first year after discharge. It is recommended that emphasis is placed on weight-management protocols (diet and exercise) to encourage a healthy lifestyle.

Evaluation of manual wheelchair performance in everyday life (Article)

2009-09-01T00:00:00Z

Evaluation of wheelchair performance (capacity and skills) is crucial in the investigation of wheeled mobility in people with a spinal cord injury (SCI). Manual wheelchair use is a complex combination of skills, which together determine overall functioning, daily activities, participation, and quality of life. The evaluation of wheelchair performance requires a systematic biophysical approach that appreciates the importance of the individual elements of the wheelchair-user combination: the wheelchair, the wheelchair-user interface, and the user, as well as the environment. Measurement technologies and outcomes of experimental and observational studies will highlight the importance of a well-balanced individual wheelchair performance.

Investigation of bias due to loss of participants in a Dutch multicentre prospective spinal cord injury cohort study (Article)

2009-04-01T00:00:00Z

Objective: To determine bias due to loss of participants (attrition bias) in a prospective cohort study. Design: A multi-centre prospective cohort study. Subjects: A total of 225 individuals with a spinal cord injury from 8 Dutch rehabilitation centres. Methods: Participants were considered non-participants when no information was collected at the measurement one year after discharge from inpatient rehabilitation. Using bivariate tests participants and non-participants were compared regarding personal, lesion, function and functional characteristics determined at the beginning of inpatient rehabilitation and at discharge. A logistic regression was performed to determine which characteristics predict participation at one year after discharge. Results: Of the participants at the start of the study, 31% (n=69) did not perform the tests one year after discharge from inpatient rehabilitation. Variables associated with study participation one year after discharge were: higher level of education, higher well-being score at the start of rehabilitation, and a shorter length of stay in hospital and rehabilitation centre at discharge of inpatient rehabilitation. Conclusion: Selective attrition in the longitudinal study might have led to an over-estimation of some of the results of the measurement one year after discharge from inpatient rehabilitation. © 2009 The Authors. Journal Compilation

A Prospective Study on Physical Activity Levels After Spinal Cord Injury During Inpatient Rehabilitation and the Year After Discharge (Article)

2008-11-01T00:00:00Z

van den Berg-Emons RJ, Bussmann JB, Haisma JA, Sluis TA, van der Woude LH, Bergen MP, Stam HJ. A prospective study on physical activity levels after spinal cord injury during inpatient rehabilitation and the year after discharge. Objectives: To assess the change over time in the physical activity level after a spinal cord injury (SCI), to explore its determinants, and to compare the physical activity level 1 year after discharge from the rehabilitation center with the level in able-bodied persons. Design: Prospective cohort study. Measurements were obtained at the start of active rehabilitation, 3 months later, at discharge, 2 months after discharge, and 1 year after discharge. Setting: Rehabilitation center in The Netherlands and the participant's home. Participants: Persons (n=40) with SCI. Interventions: Not applicable. Main Outcome Measures: The physical activity level, as indicated by the duration of dynamic activities (ie, wheelchair driving, walking, cycling, noncyclic movement) per day, and the intensity of everyday activity; both were measured with an accelerometry-based activity monitor during 2 consecutive weekdays. Results: Random coefficient analyses showed that the duration of dynamic activities and the intensity of everyday activity increased during inpatient rehabilitation at rates of 41% and 19%, respectively (P<.01). Shortly after discharge, there was a strong decline (33%; P<.001) in the duration of dynamic activities. One year after discharge, this decline was restored to the discharge level but was low in comparison with levels in able-bodied persons. The level of lesion and completeness of lesion were determinants of the change in the physical activity level after discharge. Conclusions: The physical activity level increased during inpatient rehabilitation, but this increase did not continue after discharge, and the level 1 year after discharge was distinctly lower than the level in able-bodied persons. Subpopulations had a different change over time in the physical activity level after discharge.

Prognostic Models for Physical Capacity at Discharge and 1 Year Postdischarge From Rehabilitation in Persons With Spinal Cord Injury (Article)

2007-12-01T00:00:00Z

Haisma JA, van der Woude LH, Stam HJ, Bergen MP, Sluis TA, de Groot S, Dallmeijer AJ, Bussmann JB. Prognostic models for physical capacity at discharge and 1 year postdischarge from rehabilitation in persons with spinal cord injury. Objective: To develop prognostic models for physical capacity at discharge and 1 year after discharge from inpatient rehabilitation in persons with spinal cord injury (SCI). Design: Inception cohort; data collected at start of rehabilitation (n=104), at discharge (n=81), and 1 year later (n=74). Setting: Eight Dutch rehabilitation centers. Participants: Patients with SCI at initial rehabilitation. Interventions: Not applicable. Main Outcome Measures: Physical capacity determined by endurance capacity (peak oxygen uptake [Vo2peak, in L/min] and power output [POpeak, in watts]) during a maximal exercise test, arm muscle strength, and respiratory function. Multiple regression models, either with or without prior outcome, evaluated subject, lifestyle, and lesion-related predictors. Results: Only start Vo2peak contributed to the prediction of discharge Vo2peak (R2=.51). Discharge Vo2peak contributed to its prediction 1 year later (R2=.75). Start POpeak, sex, age, and level of lesion contributed to discharge POpeak (R2=.73). Discharge POpeak, hours of employment before injury, and level of lesion contributed to POpeak 1 year later (R2=.81). Models without prior outcome explained less variance. Education, employment, body mass index, not smoking, and conservative stabilization of the spine positively contributed to endurance capacity. Muscle strength was well predicted (R2range, .68-.84). Without prior outcome, respiratory function was poorly predicted. Conclusions: Because prior outcome contributed to an accurate prediction, the early assessment of physical capacity is important in establishing prognoses. Although their accuracy warrants caution in their application, models could complement clinical expertise when informing patients about expected physical outcome and identifying those at risk of low physical capacity.

Mechanical efficiency and wheelchair performance during and after spinal cord injury rehabilitation (Article)

2007-10-01T00:00:00Z

The purpose of the present study was to investigate whether mechanical efficiency (ME) relates to wheelchair propulsion capacity and wheelchair performance tasks during and after rehabilitation of people with a spinal cord injury (SCI). Eighty participants with a SCI were tested during rehabilitation (3x) and 1 year after discharge. Two 3-minute submaximal exercise blocks, a maximal wheelchair exercise test, and four wheelchair performance tasks were performed. ME, peak power output (POpeak), the sum of the performance times of a 15-m sprint and figure-of-eight, and the heart rate reserve (%HRR) during 10 s of wheelchair propulsion on a 3% and 6% slope were calculated. The relationship between ME and POpeak, %HRR and performance time was tested with a multilevel regression analysis. ME showed a significant relationship with POpeak(p ≤ 0.002). A 1% higher ME related to a 1.6-2.2 W higher POpeak. ME of exercise block 2 was related to the sum of the performance times of a 15-m sprint and figure-of-eight; the tests were performed faster by participants with a higher ME. No relationship was found between ME and %HRR during wheelchair propulsion on a slope. ME showed a significant effect on wheelchair propulsion capacity and wheelchair performance time during and 1 yr after SCI rehabilitation although the isolated effect of ME is small.

Physical fitness in people with a spinal cord injury: The association with complications and duration of rehabilitation (Article)

2007-10-01T00:00:00Z

Objective: To assess the association between physical fitness and its recovery over time on the one hand, and complications and duration of phases of rehabilitation on the other. Design and setting: Prospective cohort study at eight rehabilitation centres. Subjects: People with a spinal cord injury were assessed four times: at the start of active rehabilitation (n = 110), three months later (n = 92), at discharge (n = 137) and a year after discharge from inpatient rehabilitation (n = 91). Main measures: Physical fitness was defined as aerobic capacity, determined at each occasion by the peak oxygen uptake (peak Vo2; L/min) and the peak power output (peak PO; W) during a maximal exercise test. On these occasions, spasticity, musculoskeletal and neurogenic pain were determined (1 = present; 0 = absent). During inpatient rehabilitation, complications (urinary tract infection, pulmonary infection or pressure sore) and bed rest were registered (1 = complication; 0 = no complications, and 1 = bed rest; 0 = no bed rest). Complications and bed rest occurring during the year after discharge were registered similarly. Results: Multilevel random coefficient analyses revealed associations in multivariate models (P ≤ 0.05). The peak oxygen uptake was negatively associated with complications after discharge. The recovery of peak power output over time was negatively associated with bed rest and spasticity. Both physical fitness and its recovery were negatively associated with the duration of active rehabilitation. Conclusion: Results suggest that limiting complications, spasticity or bed rest may improve fitness. A longer duration of active rehabilitation is not associated with an increase in physical fitness.

Complications following spinal cord injury: Occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation (Article)

2007-05-01T00:00:00Z

Objective: To assess the occurrence and risk factors for complications following spinal cord injury during and after inpatient rehabilitation. Design: Multicentre longitudinal study. Subjects: A total of 212 persons with a spinal cord injury admitted to specialized rehabilitation centres. Methods: Assessments at the start of active rehabilitation (n = 212), 3 months later (n = 143), at discharge (n = 191) and 1 year after discharge (n = 143). Results: Multi-level random coefficient analyses revealed that complications were common following spinal cord injury. Most subjects reported neurogenic and musculoskeletal pain, or had spasticity at each assessment. During the year after discharge, complications remained common: urinary tract infections and pressure sores affected 49% and 36% of the population, respectively. The degree of pain decreased, whereas the degree of spasticity increased significantly during inpatient rehabilitation. Overall, increased age, increased body mass index, traumatic lesion, tetraplegia, and complete lesion all increased the risk of complications. Conclusion: Complications are common following spinal cord injury. They need specific attention after discharge from inpatient rehabilitation and within subpopulations.