Transboundary study for the inclusion of spinal cord injured people in physical activities

Resum

The main objective of the PhD thesis was to study the degree of physical activity (PA) of people with Spinal Cord Injury (SCI) and how it’s relation to both the presence of shoulder pain (SP) and characteristics of the manual wheelchair (MWC). The study was carried out in the regions of Portugal (Algarve and Alentejo) and Spain (Huelva, Seville and Cadiz). This study was divided in two phases, a first phase of translation and cross - cultural validation of questionnaires and a second phase to focus on the physical, psychological and social level of integration that both PA and/or adaptive sports may have on the improvement of quality of life (QOL), prevalence of SP and on the impact that MWC components may have on the participation level of subjects with SCI in PA and/or QOL. Phase 1 was divided in three sub-studies (1 to 3) regarding cross - cultural validation of instruments to use in the cross-sectional study (second phase). The three sub-studies regarded the cross-cultural validation of the Physical Activity Scale for people with Physical Disabilities (PASIPD) in Portuguese and Spanish; the Quebec User Satisfaction with Assistive Technology 2.0 (QUEST 2.0) in Spanish and the Quality of Life Index (Ferrans&Powers) - SCI III (QLI - SCI III) in Portuguese and Spanish. Psychometric analysis for PASIPD, QLI (Ferrans & Powers) - SCI III and QUEST 2.0 presented higher values of internal consistency and reliability than the original versions, indicating a good test - retest. Phase 2 was divided in four sub-studies where we used the same methodology (sub-studies 4 to 7). We developed a cross-sectional evaluation of socio-demographic characteristics, level of PA, QOL, Self-perception of satisfaction with the MWC, anthropometric individual characteristics, MWC ergonomics, SP and Upper extremity isometric strength. The majority of the study participants (63,46%) were engaged in regular PA (n=33). The most performed activities were basketball (15,38%), handcycling (13,46%) and paddle/ tennis (19,23%). We observed a statistical difference in MWC dimensions for Portuguese and Spanish subjects. We also observed cases in Portugal and Spain where the subjects used only MWC or powered wheelchair (PWC) or changed PWC/MWC during the day or according to the performed activity. This was observed in subjects who presented more years since SCI and consequently have used MWC for along time. We observed that there was a significant difference in the scores for SP and MWC seats heights, for Portugal and Spain. The median values for seat height were relatively higher for people with SP. And the values of QOL were influenced by the level of PA and the MWC type. We observed a statistical difference in strength values for PA practice, in between Portuguese/ Spanish subjects, according to the presence of armrest and also for seat height. The shoulder flexion, shoulder abduction, shoulder extension and shoulder medial rotation were influenced by trunk control and the presence of SP. Seat height and years since SCI were found to influence upper extremity strength values. The seat height and presence of shoulder pain influenced shoulder lateral rotation, elbow extension, elbow flexion and shoulder flexion. There was a statistical difference in strength values among regions/provinces, mainly among Algarve/Alentejo and Seville. In conclusion, the translation and cultural validation of PASIPD (Portugal and Spain), QLI (Ferrans & Powers) SCI - Ill (Portugal and Spain) and QUEST 2.0 (Spain) was carried out. A demographic and anthropometric analysis of SCI (Algarve, Alentejo, Huelva, Seville and Cadiz) and identified type of MWC, dimensions and materials of the study areas was realized. A correlation with SP using the WUSPI with QUEST 2.0 and MWC components, PA and QOL was identified, with differences among Portugal and Spain. Subjects who were enrolled in PA and adaptive sports showed clearly higher QOL. PA also influenced strength values which were clearly higher in the Spanish group due to their bigger engagement in PA. SP was associated with heavier MWC and lower strength in the upper extremity.