Meaningful Changes in Fitness, Functional Independence, and Transfer Independence as Defined by Individuals Living with Spinal Cord Injury
Abstract
Research has shown that quality of life (QOL) after Spinal Cord Injury or Disease (SCI/D) depends more on participation, mobility, and personal care independence than on absolute severity of injury. Transfers are particularly critical to independence, with wheelchair to car, wheelchair to wheelchair, and ground to wheelchair transfers ranked by persons with SCI as skills rated in the top seven of those most essential to daily life. Fitness level is a major determinant of transfer, self-care, and mobility independence in individuals with SCI (iSCI). Individuals who have relatively more severe injuries can be as independent as persons with relatively less severe injuries can if their fitness is sufficient. Regardless of the severity of an individual’s injury, fitness can prevent or delay the loss of independence that tends to occur as iSCI age. We suggest fitness represents an underappreciated approach to meaningfully improving the independence, and thus QOL, of iSCI, no matter their age, injury severity, or time since injury. In our first award, we defined the relationship between fitness and independence and identified how fit someone must be to achieve maximal independence in bed, bathroom, car, and floor transfers. What is unknown is what changes in independence are meaningful to iSCI. It is important to know this so that an exercise intervention can be designed to achieve an independence gain that is important to iSCI. To ensure the first award could directly benefit iSCI as soon as possible, we developed a Clinical Risk Calculator to allow SCI/D clinicians and SCI/D consumers to determine the likelihood that an individual’s fitness is too low to enable independent bed, toilet-tub, car, or floor transfers. This calculator uses easy-to-gather information. However, it is very important that we determine if this calculator works well if used in different groups and by different people. The more times it works well, the more it can be trusted, and the more it will be used. For this award, we propose to (a) determine what self-care, mobility, and transfer independence changes are meaningful to iSCI, can be measured with existing research tools, and are likely to respond to fitness gains, (b) test how well one part of the calculator works in a different group of people, and (c) plan a study to test if an exercise intervention can meaningfully improve an iSCI’s independence. In the long term, this area of research will benefit iSCI who have full use of the biceps muscles in both arms but cannot use their leg muscles to help with transfers. According to the 2019 SCI Model Systems public report, 80% of the SCI/D population has full biceps function and 70% use a wheelchair or scooter for mobility (e.g., have limited or no use of their leg muscles). This report indicates that our research area will benefit a substantial proportion of all iSCI. One long-term objective is to make it easy for iSCI (or their physicians) to determine if their fitness is less than the amount needed to transfer independently. We also want to develop exercise interventions that improve independence in ways that are meaningful to iSCI. As soon as data about what changes in independence are meaningful to iSCI are published, SCI/D researchers and clinicians can begin using them to benefit iSCI. Researchers can use this information to determine if any intervention results in gains in independence that are meaningful to iSCI. This includes cell therapies like stem cells or Schwann cells, spinal cord stimulators, neuroprosthetics, and rehabilitation therapies to name a few. Currently, researchers who study if an intervention can improve function can only determine if function improves and by how much, not if the improvement is enough to be meaningful. Our data will help them judge the meaning of these improvements. SCI/D clinicians will be able to use our data about meaningful changes for individuals with acute and chronic SCI. For iSCI who are newly
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110813
Entities
People
- Rachel E Cowan
Organizations
- United States Army
- University of Alabama at Birmingham