Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam.
Rijndam Rehabilitation Institute, Rotterdam.
J Physiother. 2016 Jan;62(1):35-41. doi: 10.1016/j.jphys.2015.11.003. Epub 2015 Dec 11.
For people with subacute spinal cord injury, does rehabilitation that is reinforced with the addition of a behavioural intervention to promote physical activity lead to a more active lifestyle than rehabilitation alone?
Randomised, controlled trial with concealed allocation, intention-to-treat analysis, and blinded assessors.
Forty-five adults with subacute spinal cord injury who were undergoing inpatient rehabilitation and were dependent on a manual wheelchair. The spinal cord injuries were characterised as: tetraplegia 33%; motor complete 62%; mean time since injury 150 days (SD 74).
All participants received regular rehabilitation, including handcycle training. Only the experimental group received a behavioural intervention promoting an active lifestyle after discharge. This intervention involved 13 individual sessions delivered by a coach who was trained in motivational interviewing; it began 2 months before and ended 6 months after discharge from inpatient rehabilitation.
The primary outcome was physical activity, which was objectively measured with an accelerometer-based activity monitor 2 months before discharge, at discharge, and 6 and 12 months after discharge from inpatient rehabilitation. The accelerometry data were analysed as total wheeled physical activity, sedentary time and motility. Self-reported physical activity was a secondary outcome.
The behavioural intervention significantly increased wheeled physical activity (overall between-group difference from generalised estimating equation 21minutes per day, 95% CI 8 to 35). This difference was evident 6 months after discharge (28minutes per day, 95% CI 8 to 48) and maintained at 12 months after discharge (25minutes per day, 95% CI 1 to 50). No significant intervention effect was found for sedentary time or motility. Self-reported physical activity also significantly improved.
The behavioural intervention was effective in eliciting a behavioural change toward a more active lifestyle among people with subacute spinal cord injury.
NTR2424.
对于亚急性脊髓损伤患者，在康复治疗的基础上增加促进身体活动的行为干预，是否会比单纯康复治疗更能促进积极的生活方式？
随机、对照试验，设隐匿分组，意向治疗分析，评估者设盲。
45 名亚急性脊髓损伤的成年人，正在接受住院康复治疗，且依赖手动轮椅。脊髓损伤的特点为：四肢瘫痪 33%；运动完全性 62%；损伤后时间平均 150 天（SD 74）。
所有参与者都接受常规康复治疗，包括手摇车训练。仅实验组在出院后接受促进积极生活方式的行为干预。该干预措施包括 13 次由接受过动机访谈培训的教练提供的个体辅导课程；它在从住院康复治疗出院前 2 个月开始，在出院后 6 个月结束。
主要结局是身体活动，使用基于加速度计的活动监测器在出院前 2 个月、出院时以及从住院康复治疗出院后 6 个月和 12 个月进行客观测量。加速度计数据作为总轮式身体活动、久坐时间和活动性进行分析。身体活动的自我报告是次要结局。
行为干预显著增加了轮式身体活动（广义估计方程组间差异为 21 分钟/天，95%CI 8 到 35）。这种差异在出院后 6 个月时就显现出来（28 分钟/天，95%CI 8 到 48），并在出院后 12 个月时保持（25 分钟/天，95%CI 1 到 50）。未发现行为干预对久坐时间或活动性有显著影响。身体活动的自我报告也显著改善。
行为干预在引发亚急性脊髓损伤患者更积极的生活方式行为改变方面是有效的。
NTR2424。
