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3ABSTRACT Purpose: To gain insight into determinants of physical activity in wheelchair users with spinal cord injury or lower limb amputation, from the perspective of both wheelchair users and rehabilitation professionals. Methods: Seven focus groups were conducted: five with wheelchair users (n=25) and two with rehabilitation professionals (n¼11). The transcripts were analysed using a sequential coding strategy, in which the reported determinants of physical activity were categorized using the Physical Activity for people with a Disability (PAD) model. Results: Reported personal determinants of physical activity were age, general health status, stage of life, demotivation due to difficulty burning calories, available time and energy, balance in daily life, attitude, and history of a physically active lifestyle. Reported environmental determinants were professional guidance, inconvenient exercise times, accessibility of facilities, costs, transportation difficulties, equipment difficulties, and social support. Conclusions: Important, changeable determinants of physical activity that might be influenced in future lifestyle interventions for wheelchair users are: balance in daily life leading to more time and energy to exercise, attitude towards physical activity, professional guidance, accessibility of facilities (providing information on how and where to find accessible facilities), and social support (learning how to get this)
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Children with spina bifida who are wheelchair-users are less physically active than their typically developing peers. It is important to understand relations between physical activity and other factors, so approriate interventions can be developed. We explored relations between physical activity and fitness, age, sex and severity of disability in children that were 5–19 years of age who were diagnosed with spina bifida and who are wheelchair-users. We found that older age and the inability to walk negatively influence physical activity. We did not find a relation between physical activity and fitness or physical activity and sex.
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Objective This study aims to identify determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation, from the perspectives of both wheelchair users and rehabilitation professionals. The findings should contribute to the field of health promotion programs for wheelchair users. Methods Five focus groups were held with wheelchair users (n = 25), and two with rehabilitation professionals (n = 11). A thematic approach was used for data analysis in which the determinants were categorized using an integrated International Classification of Functioning, Disability and Health and Attitude, Social influence and self-Efficacy model. Results Reported personal factors influencing dietary behaviour in wheelchair users were knowledge, boredom, fatigue, stage of life, habits, appetite, self-control, multiple lifestyle problems, intrinsic motivation, goal setting, monitoring, risk perception, positive experiences, suffering, action planning, health condition, function impairments, attitude and self-efficacy. Reported environmental factors influencing dietary behaviour in wheelchair users were unadjusted kitchens, monitoring difficulties, eating out, costs, unfavourable food supply, nutrition education/counselling, access to simple healthy recipes, eating together, cooking for others, and awareness and support of family and friends. Conclusions Important modifiable determinants of dietary behaviour in wheelchair users that might be influenced in lifestyle interventions are knowledge, fatigue, habits, self-control, intrinsic motivation, risk perception, attitude and self-efficacy. It is recommended to involve relatives, since they appear to significantly influence dietary behaviour.
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This study is part of the WHeelchair ExercisE and Lifestyle Study (WHEELS) project and aims to identify determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation, from the perspectives of both wheelchair users and rehabilitation professionals. Results of focus groups with wheelchair users (n = 25) and rehabilitation professionals (n = 11) are presented using an integrated International Classification of Functioning, Disability and Health and Attitude, Social influence and self-Efficacy model as theoretical framework.
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Background: Low mechanical loading of the bones of wheelchair users leads to low bone mineral density (BMD) and increased risk of bone fractures and associated complications. High-load resistance training of the upper body is one way to achieve mechanical loading of the lumbar spine and the hip bones. In addition, maintaining good nutritional status with key nutrients for bone remodeling, that is, vitamin D and calcium, is important for bone accrual. Objective: This study aims to investigate the effect of 24 weeks of high-load resistance training combined with nutritional optimization on lumbar spine BMD. Secondary objectives are to investigate the effects of the intervention on (1) bone and physical health parameters, such as bone turnover blood markers, nutritional status, body composition, and maximal muscular strength, as well as (2) exercise motivation and mental health. Methods: In this randomized controlled trial, we aimed to include 60 wheelchair users with nonprogressive impairments. Participants were randomly allocated to 24 weeks of either (1) high-load resistance training and nutrition optimization or (2) nutrition optimization only, stratified by sex and sport activity status. The training program consisted of 3 weekly sessions comprising 6 exercises periodized in low-, moderate-, and high-load phases. The nutritional optimization aimed to ensure sufficient intake of protein, vitamin D, and calcium. BMD and body composition; maximal muscular strength; and nutritional, physical, and mental health status were assessed at baseline, midpoint, and postintervention visits. Furthermore, follow-up assessments of a subgroup were conducted at 6 to 18 months after the intervention. This protocol was approved by the Regional Committee for Medical and Health Research Ethics South-East, Norway. Results: Recruitment occurred between November 2022 and 2023. A total of 68 wheelchair users were screened for eligibility, of whom 45 (66%) were enrolled and allocated to one of the study groups (n=24, 53% training group; n=21, 47% control group). At the midpoint and postintervention visits, 36 (n=17, 47% and n=19, 53%, respectively) and 33 (n=14, 42% and n=19, 58%, respectively) participants were assessed, respectively. Analysis of the data collected at the screening visit commenced in spring 2024, while analyses of data collected at the baseline and retest visits began in autumn 2024. Publication of the results of this study is expected by the end of 2025. Conclusions: This protocol presents the first randomized controlled trial of a high-load resistance training intervention in wheelchair users, focusing on bone, physical, and mental health. The results will contribute to new knowledge in exercise science for this population and generate novel hypotheses for future studies.
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Purpose: To gain insight into determinants of physical activity in wheelchair users with spinal cord injury or lower limb amputation, from the perspective of both wheelchair users and rehabilitation professionals.
Methods: Seven focus groups were conducted: five with wheelchair users (n = 25) and two with rehabilitation professionals (n = 11). The transcripts were analysed using a sequential coding strategy, in which the reported determinants of physical activity were categorized using the Physical Activity for people with a Disability (PAD) model.
Results: Reported personal determinants of physical activity were age, general health status, stage of life, demotivation due to difficulty burning calories, available time and energy, balance in daily life, attitude, and history of a physically active lifestyle. Reported environmental determinants were professional guidance, inconvenient exercise times, accessibility of facilities, costs, transportation difficulties, equipment difficulties, and social support.
Conclusions: Important, changeable determinants of physical activity that might be influenced in future lifestyle interventions for wheelchair users are: balance in daily life leading to more time and energy to exercise, attitude towards physical activity, professional guidance, accessibility of facilities (providing information on how and where to find accessible facilities), and social support (learning how to get this).
Implications for rehabilitation
A physically active lifestyle improves everyday functioning, and decreases disability and the risk of secondary health problems in wheelchair users with spinal cord injury or lower limb amputation.
After inpatient rehabilitation, it is difficult for wheelchair users to maintain or further enhance their physical activity, a lifestyle intervention can help them in this.
To be effective, lifestyle interventions should address important, changeable determinants of physical activity.
Important, changeable determinants of physical activity reported by wheelchair users and rehabilitation professionals are: balance in daily life leading to more time and energy to exercise, attitude towards physical activity, professional guidance, accessibility of facilities, and social support.
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Purpose: The objective of this study was to develop a questionnaire to assess confidence in wheelchair mobility in Dutch youth (WheelCon-Mobility Dutch Youth). Methods: (1) A forward–backward translation process was used to translate the original WheelCon-M from English to Dutch. (2) Items related to wheelchair mobility in Dutch youth were selected and adapted based on focus groups with youth, parents and health care professionals to create the WheelCon-Mobility Dutch Youth. (3) The WheelCon-Mobility Dutch Youth and the Utrecht Pediatric Wheelchair Mobility Skills Test 2.0 (UP-WMST 2.0) were administered to 62 participants to evaluate internal consistency and construct validity. Results: Translation and cultural adaptation led to general adaptations in instructions, sentence structure and response scale. At the item level, 24 items were included with (n = 17) and without (n = 7) adaptation, 10 items were deleted and 7 new items were included. The WheelCon-Mobility Dutch Youth had an excellent Cronbach’s alpha of 0.924 and a significant correlation (r = 0.44, p < .001) with the UP-WMST 2.0. Conclusions: This study resulted in the adaptation of the WheelCon-M into the WheelCon-Mobility for Dutch youth using a manual wheelchair. Our study suggests there is evidence supporting the internal consistency and construct validity of the WheelCon-Mobility Dutch Youth. Implications for Rehabilitation The WheelCon-Mobility Dutch Youth is a newly developed tool for assessing confidence in wheelchair mobility in Dutch youth using a manual wheelchair. It is important to assess performance and confidence in wheelchair mobility in paediatric rehabilitation.
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Purpose: Wheelchair optimisation in clinical settings often relies on expert opinion from static wheelchair seating posture. a wheelchair ergometer provides biomechanical and physiological insights during propulsion. this study assessed the reliability of propulsion technique and physiological parameters in submaximal and sprint tests and used these values to compare two hand rim types. Materials and methods: Nineteen non-wheelchair users completed two exercise blocks per hand rim type (Gekko vs. conventional) on a wheelchair ergometer. Each block included a 4-min submaximal test and a 30 s sprint. the intraclass correlation coefficient (icc), standard error of measurement (seM) and smallest detectable change (sDc) were calculated to assess reliability for one to four exercise blocks. hand rim differences were analysed using a mixed-effects model. Results: submaximal propulsion technique showed good to excellent reliability (icc = 0.75–1.00), while physiological variables and sprint propulsion technique had moderate to excellent reliability (icc = 0.5–0.95). sDcs ranged from 12 to 29% (submaximal) and 13 to 25% (sprint), except for negative power variables (25–70%). averaging the two, three or four tests reduced sDcs by 29%, 42% and 50%, respectively, compared to one test. the Gekko rim outperformed the conventional rim in negative power (submaximal) and in distance, velocity and power (sprints). Conclusions: the submaximal test demonstrated better reliability and lower sDcs than the sprint test. the Gekko rim performed better at group level but not for every individual. Using sDcs instead of group results enhances clinical relevance. Future research should validate these findings in wheelchair users to support evidence-based wheelchair setup recommendations.
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Daily wheelchair ambulation is seen as a risk factor for shoulder problems, which are prevalent in manual wheelchair users. To examine the long-term effect of shoulder load from daily wheelchair ambulation on shoulder problems, quantification is required in real-life settings. In this study, we describe and validate a comprehensive and unobtrusive methodology to derive clinically relevant wheelchair mobility metrics (WCMMs) from inertial measurement systems (IMUs) placed on the wheelchair frame and wheel in real-life settings. The set of WCMMs includes distance covered by the wheelchair, linear velocity of the wheelchair, number and duration of pushes, number and magnitude of turns and inclination of the wheelchair when on a slope. Data are collected from ten able-bodied participants, trained in wheelchair-related activities, who followed a 40 min course over the campus. The IMU-derived WCMMs are validated against accepted reference methods such as Smartwheel and video analysis. Intraclass correlation (ICC) is applied to test the reliability of the IMU method. IMU-derived push duration appeared to be less comparable with Smartwheel estimates, as it measures the effect of all energy applied to the wheelchair (including thorax and upper extremity movements), whereas the Smartwheel only measures forces and torques applied by the hand at the rim. All other WCMMs can be reliably estimated from real-life IMU data, with small errors and high ICCs, which opens the way to further examine real-life behavior in wheelchair ambulation with respect to shoulder loading. Moreover, WCMMs can be applied to other applications, including health tracking for individual interest or in therapy settings.
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The wheelchair ergometer (Lode Esseda) can be used to monitor propulsion variables of wheelchair users, for example to evaluate wheelchair adaptations. In order to interpret the outcomes of the measurements and to support clinical decision making, it is important to distinguish real changes in propulsion technique and physiological outcomes from measurement errors.
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