Advertisement

Relationship of Fitness and Wheelchair Mobility With Encounters, Avoidances, and Perception of Environmental Barriers Among Manual Wheelchair Users With Spinal Cord Injury

      Abstract

      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.

      Keywords

      List of abbreviations:

      6MWT (6-minute walk test), ATS (American Thoracic Society), CHIEF (Craig Hospital Inventory of Environmental Factor), EAMQ (Environmental Aspects of Mobility Questionnaire), ICF (International Classification of Functioning, Disability and Health), QOL (quality of life), RER (respiratory exchange ratio), SCI (spinal cord injury), V.o2 (oxygen consumption), Vo2peak (peak oxygen consumption)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Muller R.
        • Landmann G.
        • Bechir M.
        • et al.
        Chronic pain, depression and quality of life in individuals with spinal cord injury: mediating role of participation.
        J Rehabil Med. 2017; 49: 489-496
        • Erosa N.A.
        • Berry J.W.
        • Elliott T.R.
        • Underhill A.T.
        • Fine P.R.
        Predicting quality of life 5 years after medical discharge for traumatic spinal cord injury.
        Br J Health Psychol. 2014; 19: 688-700
        • Barker R.N.
        • Kendall M.D.
        • Amsters D.I.
        • Pershouse K.J.
        • Haines T.P.
        • Kuipers P.
        The relationship between quality of life and disability across the lifespan for people with spinal cord injury.
        Spinal Cord. 2009; 47: 149-155
        • Meyers A.R.
        • Anderson J.J.
        • Miller D.R.
        • Shipp K.
        • Hoenig H.
        Barriers, facilitators, and access for wheelchair users: substantive and methodologic lessons from a pilot study of environmental effects.
        Soc Sci Med. 2002; 55: 1435-1446
        • Kilkens O.J.
        • Post M.W.
        • Dallmeijer A.J.
        • van Asbeck F.W.
        • van der Woude L.H.
        Relationship between manual wheelchair skill performance and participation of persons with spinal cord injuries 1 year after discharge from inpatient rehabilitation.
        J Rehabil Res Dev. 2005; 42: 65-73
        • Kirchberger I.
        • Biering-Sørensen F.
        • Charlifue S.
        • et al.
        Identification of the most common problems in functioning of individuals with spinal cord injury using the International Classification of Functioning, Disability and Health.
        Spinal Cord. 2010; 48: 221-229
        • Fekete C.
        • Rauch A.
        Correlates and determinants of physical activity in persons with spinal cord injury: a review using the International Classification of Functioning, Disability and Health as reference framework.
        Disability Health J. 2012; 5: 140-150
        • Tsai I.
        • Graves D.E.
        • Chan W.
        • Darkoh C.
        • Lee M.
        • Pompeii L.A.
        Environmental barriers and social participation in individuals with spinal cord injury.
        Rehabil Psychol. 2017; 62: 36-44
        • Hicks A.L.
        • Martin Ginis K.A.
        Treadmill training after SCI: it's not just about the walking.
        J Rehabil Res Dev. 2008; 45: 241-248
        • Reinhardt J.
        • Ballert C.
        • Brinkhof M.
        • Post M.
        Perceived impact of environmental barriers on participation among people living with spinal cord injury in Switzerland.
        J Rehabil Med. 2016; 48: 210-218
        • World Health Organization
        Towards a common language for functioning, disability, and health: ICF.
        World Health Organization, Geneva, Switzerland2002
        • Akkurt H.
        • Karapolat H.U.
        • Kirazli Y.
        • Kose T.
        The effects of upper extremity aerobic exercise in patients with spinal cord injury: a randomized controlled study.
        Eur J Phys Rehabil Med. 2017; 53: 219-227
        • Wilbanks S.R.
        • Rogers R.
        • Pool S.
        • Bickel C.S.
        Effects of functional electrical stimulation assisted rowing on aerobic fitness and shoulder pain in manual wheelchair users with spinal cord injury.
        J Spinal Cord Med. 2016; 39: 645-654
        • Groot S.D.
        • Scheer J.W.
        • Bakkum A.J.
        • et al.
        Wheelchair-specific fitness of persons with a long-term spinal cord injury: cross-sectional study on effects of time since injury and physical activity level.
        Disabil Rehabil. 2016; 38: 1180-1186
        • Nooijen C.F.
        • Post M.W.
        • Spooren A.L.
        • et al.
        Exercise self-efficacy and the relation with physical behavior and physical capacity in wheelchair-dependent persons with subacute spinal cord injury.
        J Neuroeng Rehabil. 2015; 12: 103
        • Hicks A.L.
        • Martin K.A.
        • Ditor D.S.
        • et al.
        Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being.
        Spinal Cord. 2003; 41: 34-43
        • Hicks A.L.
        • Ginis K.A.
        • Pelletier C.A.
        • Ditor D.S.
        • Foulon B.
        • Wolfe D.L.
        The effects of exercise training on physical capacity, strength, body composition and functional performance among adults with spinal cord injury: a systematic review.
        Spinal Cord. 2011; 49: 1103-1127
        • Noreau L.
        • Shephard R.J.
        Return to work after spinal cord injury: the potential contribution of physical fitness.
        Paraplegia. 1992; 30: 563-572
        • van Velzen J.M.
        • de G.S.
        • Post M.W.
        • Slootman J.H.
        • van Bennekom C.A.
        • van der Woude L.H.
        Return to work after spinal cord injury: is it related to wheelchair capacity at discharge from clinical rehabilitation?.
        Am J Phys Med Rehabil. 2009; 88: 47-56
        • Tolerico M.L.
        • Ding D.
        • Cooper R.A.
        • et al.
        Assessing mobility characteristics and activity levels of manual wheelchair users.
        J Rehabil Res Dev. 2007; 44: 561-571
      1. ICF CHECKLIST Version 2.1a, Clinician Form: for International Classification of Functioning, Disability, and Health. World Health Organization, Geneva, Switzerland2003
        • Shumway-Cook A.
        • Patla A.
        • Stewart A.
        • Ferrucci L.
        • Ciol M.A.
        • Guralnik J.M.
        Environmental components of mobility disability in community-living older persons.
        J Am Geriatr Soc. 2003; 51: 393-398
        • Lien W.
        • Chang J.
        • Guo N.
        • Lin Y.
        • Hsieh P.
        • Kuan T.
        Determinants of perceived physical environment barriers among community-dwelling elderly in Taiwan.
        J Nutr Health Aging. 2015; 19: 575-582
        • Cao Y.
        • Walker E.A.
        • Krause J.S.
        Environmental barriers and subjective health among people with chronic spinal cord injury: a cohort study.
        J Spinal Cord Med. 2014; 38: 526-531
        • Hirvensalo M.
        • Rantanen T.
        • Heikkinen E.
        Mobility difficulties and physical activity as predictors of mortality and loss of independence in the community-living older population.
        J Am Geriatr Soc. 2000; 48: 493-498
        • Dallmeijer A.J.
        • Kilkens O.J.
        • Post M.W.
        • et al.
        Hand-rim wheelchair propulsion capacity during rehabilitation of persons with spinal cord injury.
        J Rehabil Res Dev. 2004; 42: 55-63
        • Portegijs E.
        • Rantakokko M.
        • Viljanen A.
        • Rantanen T.
        • Iwarsso S.
        Perceived and objective entrance-related environmental barriers and daily out-of-home mobility in community-dwelling older people.
        Arch Gerontol Geriatr. 2017; 69: 69-76
      2. ATS statement: guidelines for the six-minute walk test.
        Am J Respir Crit Care Med. 2002; 166: 111-117
        • Cowan R.E.
        • Callahan M.K.
        • Nash M.S.
        The six minute push test is reliable and predicts fitness level in spinal cord injury.
        Med Sci Sports Exerc. 2012; 44: 1993-2000
        • Whiteneck G.G.
        • Harrison-Felix C.L.
        • Mellick D.C.
        • Brooks C.A.
        • Charlifue S.B.
        • Gerhart K.A.
        Craig Hospital Inventory of Environmental Factors.
        PsycTESTS Dataset. 2001;
        • Mahoney E.T.
        • Jacobs P.L.
        • Johnson B.M.
        Reliability of arm Wingate anaerobic testing in persons with complete paraplegia.
        Med Sci Sports Exerc. 2002; 34: S229
        • Jacobs P.L.
        • Johnson B.
        • Somarriba G.
        Reliability of upper extremity Wingate anaerobic testing in persons with complete tetraplegia.
        Med Sci Sports Exerc. 2004; 36: S115
        • Jacobs P.L.
        • Johnson B.
        • Somarriba G.A.
        • Carter A.B.
        Reliability of upper extremity anaerobic power assessment in persons with tetraplegia.
        J Spinal Cord Med. 2005; 28: 109-113
        • Jacobs P.L.
        • Mahoney E.T.
        • Johnson B.
        Reliability of arm Wingate Anaerobic Testing in persons with complete paraplegia.
        J Spinal Cord Med. 2003; 26: 141-144
        • Martel G.
        • Noreau L.
        • Jobin J.
        Physiological responses to maximal exercise on arm cranking and wheelchair ergometer with paraplegics.
        Paraplegia. 1991; 29: 447-456
        • Shephard R.J.
        Fitness in special populations.
        Human Kinetics Publishers, Champaign, IL1990
        • Kirby R.L.
        • Keeler L.
        • Wang S.
        • Thompson K.
        • Theriault C.
        Proportion of wheelchair users who receive wheelchair skills training during an admission to a Canadian rehabilitation center.
        Top Geriatr Rehabil. 2015; 31: 58-66
        • Martin Ginis K.A.
        • Jörgensen S.
        • Stapleton J.
        Exercise and sport for persons with spinal cord injury.
        PM R. 2012; 4: 894-900
        • Tasiemski T.
        • Kennedy P.
        • Gardner B.P.
        • Taylor N.
        The association of sports and physical recreation with life satisfaction in a community sample of people with spinal cord injuries.
        NeuroRehabilitation. 2005; 20: 253-265
        • Rantanen T.
        • Guralnik J.M.
        • Leveille S.
        • et al.
        Racial differences in muscle strength in disabled older women.
        J Gerontol A Biol Sci Med Sci. 1998; 53: B355-B361
        • Fried L.P.
        • Guralnik J.M.
        Disability in older adults: evidence regarding significance, etiology, and risk.
        J Am Geriatr Soc. 1997; 45: 92-100
        • van der Woude L.H.
        • Veeger D.J.
        • Rozendal R.H.
        • Sargeant T.J.
        Seat height in handrim wheelchair propulsion.
        J Rehabil Res Dev. 1989; 26: 31-50
        • Macphee A.H.
        • Kirby R.
        • Coolen A.L.
        • Smith C.
        • Macleod D.A.
        • Dupuis D.J.
        Wheelchair skills training program: a randomized clinical trial of wheelchair users undergoing initial rehabilitation.
        Arch Phys Med Rehabil. 2004; 85: 41-50
        • Field-Fote E.
        Spinal cord injury rehabilitation.
        FA Davis, Philadelphia2009
        • Mortenson W.B.
        • Miller W.C.
        • Backman C.L.
        • Oliffe J.L.
        Association between mobility, participation, and wheelchair-related factors in long-term care residents who use wheelchairs as their primary means of mobility.
        J Am Geriatr Soc. 2012; 60: 1310-1315
        • Noreau L.
        • Shephard R.
        • Simard C.
        • Paré G.
        • Pomerleau P.
        Relationship of impairment and functional ability to habitual activity and fitness following spinal cord injury.
        Int J Rehabil Res. 1993; 16: 265-275
        • Curtis K.A.
        • McClanahan S.
        • Hall K.M.
        • Dillon D.
        • Brown K.F.
        Health, vocational and functional status in spinal cord injured athletes and non-athletes.
        Arch Phys Med Rehabil. 1986; 67: 862-865
      3. Americans with Disabilities Act (ADA) Accessibility Guidelines (ADAAG), 2002.

      4. Americans with Disabilities Act of 1990, .

      5. Spinal cord injury facts and figures at a glance.
        J Spinal Cord Med. 2014; 37: 659-660
        • Kirby R.L.
        • Miller W.C.
        • Routhier F.
        • et al.
        Effectiveness of a wheelchair skills training program for powered wheelchair users: a randomized controlled trial.
        Arch Phys Med Rehabil. 2015; 96: 2017-2026

      Reference

        • World Health Organization
        Towards a common language for functioning, disability, and health: ICF.
        World Health Organization, Geneva, Switzerland2002