Wheelchair mobility in the daily life of manual wheelchair users with spinal cord injury

Abstract

Introduction & Purpose: For persons with a spinal cord injury (SCI), mobility and an active lifestyle are very important to maintain an independent and healthy life. A recent study showed that only 54% of the Swiss population with SCI meet the starting level indicated in the SCI-specific guidelines on aerobic activity (≥2 x 20 mins/week of moderate to vigorous activity) and only 36% those for strength training (≥3 sets twice a week) (de Vries et al., 2024; Martin Ginis et al., 2018). Daily wheelchair mobility is also a form of physical activity which can support a healthy lifestyle, but comprehensive data on the extent of mobility in this population is missing. The aim of this study is to describe wheelchair mobility in manual wheelchair users with SCI living in Switzerland and to evaluate determinants of between-person variation in wheelchair mobility.

Methods: One inertial measurement unit was placed on the wheel of manual wheelchair users and collected data for seven consecutive days. The following variables were derived from the real-life measurements to describe wheelchair mobility: distance covered, number of pushes and turns (>30°), and number of bouts of mobility (defined as duration ≥5 seconds and speed ≥0.12 m/s) with the according distance (de Vries et al., 2023). Logistic regression analyses will be used to identify determinants of between-persons variability in wheelchair mobility. Confounders for wheelchair mobility include sex, age, lesion severity, shoulder pain and independence in daily life.

Results: 45 manual wheelchair users participated: 7 women, 38 men, 39 persons with paraplegia and 6 with tetraplegia, with a mean age of 56 ± 12 years and 26 ± 16 years since injury.

Preliminary results show that mean active propulsion time per day over all participants was 56 ± 32 minutes. On average, participants covered 4949 ± 8150 meters per day, corresponding to 2030 ± 1298 pushes and 929 ± 441 turns per day. Daily distance covered was highly variable, ranging from 329 to 51831 m (performed with an attach-unit handbike). In general, participants performed 199 ± 83 bouts of mobility per day with an average distance per bout of 27 ± 51 m. Determinants of between-person mobility are still under evaluation.

Discussion/Conclusion: Even though many manual wheelchair users indicate to not engage in a specific aerobic training of 2 x 20 min of moderate to vigorous activity per week, they are actively propelling their wheelchair for 56 min daily, which also counts as aerobic activity. However, compared to a subgroup of able-bodied persons older than 52 years living in Switzerland, who were engaged in 188 min of light to vigorous activities per day, daily propulsion time in manual wheelchair users is rather low (Aebi et al., 2020).

Our results also showed that wheelchair mobility and activity have a high interindividual variability within the studied group. The planned analysis of determinants of this variability may indicate which individuals are the least active and could profit most from targeted interventions and efforts to remove barriers for daily mobility.

References

Aebi, N. J., Bringolf-Isler, B., Schaffner, E., Caviezel, S., Imboden, M., & Probst-Hensch, N. (2020). Patterns of cross-sectional and predictive physical activity in Swiss adults aged 52+: results from the SAPALDIA cohort. Swiss Med Wkly, 150, w20266. https://doi.org/10.4414/smw.2020.20266

de Vries, W. H. K., Arnet, U., Bossuyt, F. M., de Groot, S., Eriks-Hoogland, I., & Perret, C. (2024). Adherence to Physical Activity Guidelines in Manual Wheelchair Users With Spinal Cord Injury and the Association With Shoulder Pain. Am J Phys Med Rehabil, 103(11S Suppl 3), S303-S309. https://doi.org/10.1097/PHM.0000000000002584

de Vries, W. H. K., van der Slikke, R. M. A., van Dijk, M. P., & Arnet, U. (2023). Real-Life Wheelchair Mobility Metrics from IMUs. Sensors (Basel), 23(16), 7174. https://doi.org/10.3390/s23167174

Martin Ginis, K. A., van der Scheer, J. W., Latimer-Cheung, A. E., Barrow, A., Bourne, C., Carruthers, P., Bernardi, M., Ditor, D. S., Gaudet, S., de Groot, S., Hayes, K. C., Hicks, A. L., Leicht, C. A., Lexell, J., Macaluso, S., Manns, P. J., McBride, C. B., Noonan, V. K., Pomerleau, P., Rimmer, J. H., Shaw, R. B., Smith, B., Smith, K. M., Steeves, J. D., Tussler, D., West, C. R., Wolfe, D. L., & Goosey-Tolfrey, V. L. (2018). Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord, 56(4), 308-321. https://doi.org/10.1038/s41393-017-0017-3