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Is There an Association Between Markers of Cardiovascular Autonomic Dysfunction at Discharge From Rehabilitation and Participation 1 and 5 Years Later in Individuals With Spinal Cord Injury?

  • H.J. (Rianne) Ravensbergen
    Affiliations
    Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada

    International Collaboration On Repair Discoveries, Vancouver, BC, Canada

    Research Institute MOVE Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
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  • Sonja de Groot
    Affiliations
    Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands

    Center for Human Movement Sciences Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • Marcel W. Post
    Affiliations
    Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat, Utrecht, The Netherlands

    Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • Helma M. Bongers-Janssen
    Affiliations
    Rehabilitation Center Adelante, Hoensbroek, The Netherlands
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  • Lucas H. van der Woude
    Affiliations
    Center for Human Movement Sciences Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • Victoria E. Claydon
    Correspondence
    Corresponding author Victoria E. Claydon, PhD, Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
    Affiliations
    Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada

    International Collaboration On Repair Discoveries, Vancouver, BC, Canada
    Search for articles by this author
Published:April 12, 2016DOI:https://doi.org/10.1016/j.apmr.2016.03.010

      Abstract

      Objectives

      To determine whether physical activity and participation 1 and 5 years after discharge are associated with measures of cardiovascular autonomic function: prevalence of hypotension and reduced peak heart rate at discharge from initial inpatient spinal cord injury (SCI) rehabilitation.

      Design

      Prospective cohort study.

      Setting

      Rehabilitation centers.

      Participants

      Individuals with SCI (N=146).

      Interventions

      Not applicable.

      Main Outcome Measures

      We recorded markers of cardiovascular autonomic dysfunction (resting blood pressure and peak heart rate) and personal and lesion characteristics at the time of discharge from rehabilitation. Parameters for participation (social health status dimension of the Sickness Impact Profile) and physical activity (Physical Activity Scale for Individuals with Physical Disabilities [PASIPD]) were measured 1 and 5 years after discharge. Effects of prevalence of cardiovascular autonomic dysfunction were analyzed using linear regression analysis while correcting for possible confounders.

      Results

      We found no significant association between hypotension and social health status dimension of the Sickness Impact Profile or PASIPD, either at 1 or at 5 years after discharge. A significant association between peak heart rate and social health status dimension of the Sickness Impact Profile was found at 1 year after discharge, showing poorer participation in individuals with low peak heart rate (ie, cardiovascular autonomic dysfunction). The unadjusted relation between peak heart rate and the social health status dimension of the Sickness Impact Profile was significant at 5 years, but not when adjusted for confounders. We found associations between peak heart rate and PASIPD for both 1 and 5 years after discharge; however, these were not significant after correction for potential confounding factors.

      Conclusions

      Autonomic dysfunction after SCI is a crucial factor influencing quality of life. We found that cardiovascular autonomic impairment, assessed from low peak heart rate, was associated with reduced participation after 1 year. The results suggest that peak heart rate at discharge from rehabilitation after SCI should be used to identify those needing additional support to facilitate physical activity and participation after discharge.

      Keywords

      List of abbreviations:

      AIS (ASIA Impairment Scale), PASIPD (Physical Activity Scale for Individuals with Physical Disabilities), SCI (spinal cord injury), TSI (time since injury)
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