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Regular physical activity is important for people with tetraplegia to maintain fitness but may not always be easily integrated into daily life. In many countries, hand cycling has become a serious option for daily mobility in people with tetraplegia. However, little information exists regarding the suitability of this exercise mode for this population. The purpose of this study was to evaluate the effects of a structured hand cycle training program in individuals with chronic tetraplegia. Pretraining and posttraining outcome measurements of physical capacity were compared. Structured hand cycle interval training was conducted at home or in a rehabilitation center in the Netherlands. Twenty-two patients with tetraplegia (American Spinal Injury Association Impairment Scale classification A-D) at least 2 years since injury participated. The intervention was an 8- to 12-week hand cycle interval training program. Primary outcomes of physical capacity were: peak power output (POpeak) and peak oxygen uptake (Vo(2)peak), as determined in hand cycle peak exercise tests on a motor-driven treadmill. Secondary outcome measures were: peak muscle strength (force-generating capacity) of the upper extremities (as assessed by handheld dynamometry), respiratory function (forced vital capacity and peak expiratory flow) and participant-reported shoulder pain. Significant improvements following a mean of 19 (SD=3) sessions of hand cycle training were found in POpeak (from 42.5 W [SD=21.9] to 50.8 W [SD=25.4]), Vo(2)peak (from 1.32 L.min(-1) [SD=0.40] to 1.43 L.min(-1) [SD=0.43]), and mechanical efficiency, as reflected by a decrease in submaximal oxygen uptake. Except for shoulder abduction strength, no significant effects were found on the secondary outcomes. Common health complications, such as urinary tract infections, bowel problems, and pressure sores, led to dropout and nonadherence. Patients with tetraplegia were able to improve their physical capacity through regular hand cycle interval training, without participant-reported shoulder-arm pain or discomfort.

Background Since physical activity and exercise levels are known to be generally low in persons with spinal cord injury (SCI), there seems to be a need for intervention. Exercise self-efficacy (ESE), the confidence persons have in their ability to be physically active and exercise, is an important and modifiable predictor of physical behavior. The goal of this study was to 1) describe ESE in persons with subacute SCI, 2) to assess ESE in subgroups based on demographic and lesion characteristics, and 3) to explore the relation between ESE and physical behavior and physical capacity. Methods Thirthy-seven persons with subacute SCI who are wheelchair dependent participated. Participants completed the Exercise Self-Efficacy Scale. We recorded age and lesion characteristics, measured physical behavior (physical activity, motility and sedentary day time, n  = 35) with an accelerometer-based activity monitor and measured physical capacity (peak power output, n  = 28 and peak oxygen uptake, n  = 24) during a maximal hand-cycling test. Measurements were performed 2 months prior to discharge from inpatient rehabilitation. Mann-Whitney tests were used to test for differences between subgroups based on age and lesion characteristics and spearman correlations were used to assess the relation between ESE and physical activity and physical capacity. Results Persons with tetraplegia had lower ESE compared to persons with paraplegia (Z = −1.93, p  = 0.05). No differences in ESE were found between subgroups based on age and motor completeness of the lesion. In persons with paraplegia, ESE was positively related to peak power output ( ρ  = 0.58, p  = 0.02). The relation of ESE with wheeled physical activity was ρ  = 0.36, p  = 0.09. Conclusions In persons with SCI who are dependent on a manual wheelchair, lesion level when categorized as paraplegic and tetraplegic affected ESE whereas age categories and completeness categories did not. Persons with tetraplegia were found to have lower confidence with regard to physical activity and exercise indicating that this subgroup can benefit from extra attention in the promotion of physical activity and exercise. In persons with paraplegia, ESE seemed to be lower in persons with less peak power output and less daily physical activity.

This study investigated the reliability and validity of the Korean version of the Utrecht Scale for Evaluation of Rehabilitation-Participation (K-USER-P) in patients with stroke. Stroke patients participated in this study. The Utrecht Scale for Evaluation of Rehabilitation-Participation was translated from English into Korean. A total of 120 questionnaires involving the K-USER-P were distributed to rehabilitation hospitals and centers by mail. Of those, 100 questionnaires were returned and 67 were included in the final analysis after exclusion of questionnaires with insufficient responses. We analyzed the questionnaires for internal consistency, test-retest reliability, and construct validity. The results indicated that internal consistency coefficients of the frequency, restriction, and satisfaction domains were 0.69, 0.66, and 0.67, respectively. Test-retest reliability was 0.63, 0.45, and 0.71 for the three domains, respectively. Intercorrelations between the SF-12 and the London Handicap Scale were generally moderate to good. The Korean version of the Utrecht Scale for Evaluation of Rehabilitation-Participation can be used as a measure of the participation level of stroke patients in clinical practice and the local community.

Study designCross-sectional psychometric study.ObjectivesTo compare psychometric properties of the Connor–Davidson Resilience Scale (CD-RISC) with 25, 10, and 2 items, and to assess the agreement between these versions in individuals with spinal cord injury (SCI).SettingStandard psychological screening at a Dutch rehabilitation centre during the first 2 weeks of inpatient rehabilitation.MethodsAnonymous data from the psychological screening were analysed. CD-RISC outcomes were checked for floor and ceiling effects. Internal consistency was assessed by calculating Cronbach’s α. Convergent validity was assessed by Spearman’s correlation between resilience and anxiety, depression, passive coping, and life satisfaction. Agreement between CD-RISC versions was examined by calculating intraclass correlation coefficients (ICCs), corresponding 95% confidence intervals (CIs), and Bland–Altman plots.ResultsTotal CD-RISC scores were only skewed on the CD-RISC 2 (−1.12). There were no floor and ceiling effects. Internal consistency of the 25-, 10-, and 2-item scales was good to moderate (0.90, 0.86, and 0.66, respectively). Good convergent validity was shown only for the CD-RISC 10. Agreement was highest between the CD-RISC 25 and CD-RISC 10 with an ICC of 0.90 with 95% CI from 0.85 to 0.94.ConclusionsOut of the three CD-RISC versions, the CD-RISC 10 showed the best combination of reliability, validity, and practicality. Therefore, this version is advised as measure of resilience in individuals with SCI in a rehabilitation setting. Measurement of resilience could be part of a psychological screening to identify individuals at risk to develop psychological problems after SCI.

Study designExpert opinion, feedback, revisions and final consensus.ObjectivesTo update the International Spinal Cord Injury (SCI) Core Data Set while still retaining recommended standardization of data reporting.SettingInternational.MethodsComments on the data elements received from the SCI community were discussed in the International Core Data Set working group. The suggestions from this group were iteratively reviewed. The final version was circulated for final approval.ResultsThe International SCI Core Data Set (Version 3.0) consists of 21 variables. The variable ‘Gender’ has been changed to ‘Sex assigned at birth’; for the variable ‘Spinal Cord Injury Etiology’, the item, ‘Sports or exercise during leisure time’, has been clarified as ‘including during leisure time’; for the variables ‘Vertebral injury’ and ‘Associated injuries’, the item ‘Unknown’ is reworded into: ‘Not applicable (non-traumatic case)’ and ‘Unknown’; the variable ‘Spinal surgery’ has been expanded to include surgeries for individuals with non-traumatic SCI; for the variables related to the International Standards for Neurological Classification of SCI only the neurological level of injury (NLI) and the American Spinal Injury Association (ASIA) Impairment Scale (AIS) are to be reported, and a separate variable is included indicating if the NLI or the AIS or both are impacted by a non-SCI condition.ConclusionThe International SCI Core Data Set (Version 3.0) should be collected and reported for all studies of SCI to facilitate uniform descriptions of SCI populations and facilitate comparison of results collected worldwide.

The aim of this article is to study inclusion and recognition experienced amongst people with a Spinal Cord Injury (SCI) in Norway, The Netherlands, and Australia. This is approached both from the perspectives of an interest in the impact of mobility limitations versus social attitudes, and from a consideration of differences between societies. The data derive from the core questionnaire of International Spinal Cord Injury Community Survey with extended national modules on the attitudes and values of respondents from Norway, The Netherlands, and Australia. The data gathered in 2017-18 include 2,450 participants aged 18 years or older. The data are analysed and presented with descriptive statistics and OLS regression analyses. In order to explore our main questions, we run regression controlling for country effects in addition exploring within country effects. Mobility limitations are a substantially weaker predictor of self-perceived inclusion and recognition than experiences of negative attitudes towards disabled people. Stereotypical attitudes and norms in society are shown to have various impacts on inclusion in the three countries. The Norwegian respondents report overall better results on inclusion and recognition than respondents in Australia and The Netherlands, illustrating the importance of national contexts. Challenges associated with inclusion, recognition, and respect after SCI need to be defined in a language broader than mobility limitations and stereotypical attitudes towards people with an SCI. The main road to both inclusion and recognition in society is primarily linked to job and educational status, in addition to family and friends. The results are of particular interest as measures to support reintegration into society, including a strengthening of labour market integration programs.

Purpose To determine the relationships between impact of secondary health conditions (SHCs), treatment of SHCs, and life satisfaction (LS) following spinal cord injury (SCI) across 21 countries. Hypotheses were as follows: (1) Persons with SCI and fewer SHCs report higher LS and (2) Persons who receive treatment for SHCs report higher LS than those who do not receive treatment. Methods Cross-sectional survey, including 10,499 persons with traumatic or non-traumatic SCI aged 18 years or older and living in the community. To assess SHCs, 14 items adapted from the SCI-Secondary Conditions Scale were used (range 1–5). SHCs index was calculated as the mean of all 14 items. LS was assessed using a selection of 5 items from the World Health Organization Quality of Life Assessment. LS index was calculated as the mean of these 5 items. Results South Korea, Germany, and Poland exhibited the highest (2.40–2.93) and Brazil, China, and Thailand the lowest (1.79–1.90) impact of SHCs. Indexes for LS and SHCs were inversely correlated (– 0.418; p  < 0.001). Mixed Model Analysis showed that the fixed effect (key predictors of the study) of SHCs index ( p  < 0.001) and the positive interaction between SHCs index and treatment ( p  = 0.002) were significant determinants of LS. Conclusion Persons with SCI across the world are more likely to perceive better LS if they experience fewer SHCs and receive treatment for SHCs, in comparison to those who do not. Prevention and treatment of SHCs following SCI should be a high priority in order to improve the lived experience and enhance LS.

Study designA register based cohort study.ObjectivesTo investigate labour market participation following spinal cord injury (SCI) and to describe the impact of personal and SCI characteristics.SettingNorway.MethodsPersons registered with SCI in the Norwegian SCI registry 2011–2017, and matched reference individuals without SCI from the general population (named controls) were followed for up to six years after injury using national registry data on employment, education, income, and social security benefits. Main measures of labour market participation were: (1) Receiving any amount of pay for work, and (2) Receiving sickness and disability benefits.ResultsAmong the 451 persons with SCI (aged 16–66 years and working before injury), the estimated percentages receiving pay for work and sickness and disability benefits in the sixth years after injury were 63% (95% CI 57–69) and 67% (95% CI 61–72).Corresponding percentages for the controls (n = 1791) were 91% (95% CI 90–93) for receiving pay for work and 13% (95% CI 12–15) for receiving sickness and disability benefits. Among persons with SCI, less severe neurological outcome, higher level of education, younger age at injury, and a stronger pre-injury attachment to employment (higher employment income, having an employer, less receipt of benefits), were associated with higher labour market participation.ConclusionSCI substantially decreased labour market participation up to six years after injury compared to matched controls. Even if a relatively large proportion of persons with SCI remained in some degree of work activity, more than half did so in combination with receiving benefits.

Study designCross-sectional study.ObjectivesWork-related disability is common in persons with spinal cord injury (SCI). The aims of this study are to examine the associations of employment with self-perceived health (SPH) and quality of life (QoL) across 22 countries and to explore the covariates around employment and SPH and QoL.SettingCommunity.MethodsWe analyzed 9494 community-dwelling persons with SCI aged 18–65. We performed an adjusted regression and path analysis. The independent variable was ‘employment’ and the dependent variables were two single items: QoL (very poor to very good) and SPH (excellent to poor). Covariates included the Gross Domestic Product (GDP), education, time since SCI, age, gender, years of employment after SCI, SCI level (paraplegia, tetraplegia), and completeness of SCI.ResultsParticipants’ mean age was 47, 74% were male, and 63% had paraplegia. We found an association between employment and QoL and SPH. While the magnitude of the effect of employment on QoL did not differ across GDP quartiles, its perceived effect on QoL was found to be significant in the highest GDP quartile. Employment was predictive of good SPH in two GDP quartiles (Q1 and Q4), but significant across all quartiles when predicting poor perceptions, with the magnitude of effect varying significantly.ConclusionsEmployment is closely related to QoL and SPH depending on the GDP. We may positively influence the QoL and SPH in the SCI population to promote better employment outcomes by considering the infrastructure and economy.