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S.GHORBEL-M.GUERMAZI- M.CHEBIL

Physical and Rehabilitation Medicine

King Fahd General Hospital Jeddah

Faculty of Medicine Tunis

Introduction Persons with SCI

Physical aptitude : Reduced

Psychological impact: Anxiety , depression, lack of self-esteem, ….

Social integration: Risk of isolation Aggressiveness or antisocial attitude

Leading to underutilization of real capacities

Physical activity and sport have demonstrated a positive impact on physical aptitude and wellbeing of healthy people

Physical activity is nowadays one of the methods proposed in the rehabilitation of paraplegic patients

What is the real impact in SCI persons??

Introduction Goals

To Assess the effect of regular physical activity on :

Autonomy

Quality of Live QOL

of Tunisian paraplegic Patients

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METHODS

Inclusion criteria Exclusion criteria

T1-L5

Neurologically stable

Mobility on wheel chair

Independently of

Sex / Age

Etiology,

Type : complete or incomplete

TBI

Limb traumatism/ amputation

Psychiatric disorders

Refusal to participate

Case –control Study : 25 subjects

2 GROUPS: 10 athletes, 15 sedentary

The athletes were recruited from the Professional Rehabiltation Center

METHODS

ASSESSMENT

Clinical Status : History / Physical Examination

Functional Status : FIM (Functional Independance Measure)

QOL Status : SF-36 (Medical Outcome Study Short Form 36)

METHODS Clinical Status

Clinical Assessment:

Age /Gender / Duration of paraplegia

Neurological Level (motor/sensitive) : ASIA

Presence of complication (spasticity/contracture/sores...)

Educational Level,profession...

METHODS Functional Status

FIM : Assesses the capacity and autonomy in 6 activities:

Self- care

Sphincter control

Transfer

Locomotion and mobility

Communication

Social integration

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18 items: -13 *motor*: feeding, grooming, bathing, dressing ,toileting, bladder and bowel management, transfer, walking or using wheelchair

-5 *cognition*: comprehension, expression, social interaction, memory and problem solving

Each item is scored from 1 to 7

The score 7 correspond to a total independence

Person is considered dependant if score < 80/126

METHODS Functional Status FIM

METHODS Quality of Life Assessment SF- 36

Assessment of quality of life by the Arabic version of MOS SF-36 (Medical Outcome Study Short Form 36) validated in Arabic

Questionnaire with satisfactory psychometric properties,

METHODS

Quality of Life Assessment SF- 36

36 items divided into 8 dimensions :

1) Physical activity : PF (Physical Functionning)

2) Limitations of physical activity : RP (Role Physical)

3) Pain perception : BP (Bodily Pain)

METHODS Quality of Life Assessment SF- 36

4) Perception of health : GH (General Health)

5) Vitality : VT (Vitality)

6) Social activity : SF (Social functionning)

7) Mental Health : MH (Mental Health)

8) The impact of mental health on daily activities : RE

(Role Emotionnal)

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METHODS

Quality of Life Assessment SF- 36

Two sub-score:

Physical Global Score(PCS) : average PF, RP, BP , GH

Mental Global Score(MCS) : average VT, SF, RE ,MH

Patient responses are present in the form of a profile. A weighted score is calculated for each category. This score ranges from 0 to 100.

Higher score indicating higher level of function and/or better health

RESULTS

RESULTS

p 15 Sedentary 10 Athletes

NS

NS

NS

NS

NS

7,6 (18-43) ±29,13

0,8

D10 L3

ASIA A 11

ASIA C 4

Secondary 11

54,9 (30-228) ±50,9

4 (17-30) ±22,2

0,25

D8 L2

ASIA A 8

ASIA C 2

Secondary 7

19,3 (13-64)±34,5

7,4 ±13,7

2,2 ±4,4

Age

Sex-ratio M/F

Neurologic level

Education

Evolution of the paraplegia(month)

Sport’s activities (month)

Nb Hours/W

RESULTS P Non sportifs Sportifs Moyennes des differents scores

<0,001

0,143

<0,001

0,080

<0,001

0,013

0,533

0,124

0,007

0,004

<0,001

0,052

93,87

6,20

4,13

6,20

3,47

4,13

5,40

5,60

4,8

3,60

3,60

4,73

115,10

7

7

7

7

6,40

5,80

6,60

7

6,30

7

6

Global score

Grooming

Bathing

Dressing upper body

Dressing lower body

Toileting

Bladder management

Bowel management

Transfer bed/chair

Transfer toilet

Transfer bath or shower

Locomotion

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Results Group Athletes Group Sedentary p

Physical Functionning 57.5 ± 14.1 > 49.6 ± 10.6 0.12

Role Physical 27.5 ± 21.8 > 16.6 ± 29.3 0.33

Bodily Pain 52 ± 41.3 > 23 ± 9.2 0.01

General Health 44.6 ± 18.9 > 30.9 ± 24.5 0.14

Vitality 48.2 ± 21.1 > 31.3 ± 19.5 0.04

Social Functionning 47.5 ± 50.6 < 55.3 ± 44.5 0.67

Mental Health 40.6 ± 11.7 > 38 ± 17.6 0.68

Role Emotional 30 ± 48.3 > 20 ± 41.4 0.58

Physical Global Score 45.4 ± 12.4 > 30 ± 13.2 0.008

Mental Global Score 41.5 ± 25.7 > 36.1 ± 18.8 0.54

Discussion

Our study suggests the positive impact of sport on QOL in

paraplegics

- Significant difference in VT, BP and PCS

- Averages of different dimensions of SF-36 are higher in

athletes (except for SF)

Discussion

Physical activity is a factor of improving functional activities

Significant differences : personal care and transfer

For the locomotion no significant differences: negative impact of the architectural barriers and the difficulty of mobility on wheelchair??

Discussion

Encouraging results although : - 4 h / wk training only

- leisure Activity-dependent of the stay in the center

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Discussion Limits of our study:

Size of the population

The impact of certain factors:

socio- economic

spasticity….

Discussion

Discussion Literature Review : 11 STUDIES

Cross sectional :6 studies Interventional :5 studies

Analyze the influence of

physical activities on the QOL

and /or functional

independence , without

performing intervention

Interventional program whith

aerobic activities,

weight training,

gait, or swimming

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Discussion A positive , strong association between physical activity and

Both QOL And Functional Autonomy

The inclusion of both aerobic and resistance exercises

The volume of physical activity > 4 h/week

Discussion The role of exercise and sports:

Physiological Impact:

preventing chronic disease

enhancing physical fitness (capacity, strength, body composition...)

functional performance

Psychological Impact: Overcome his depression

feeling of well being

Restoration of body image and maintaining self-esteem

Social Impact:

Build social relationships through leisure activities with

others, spirit of competition and combativeness

BARRIER FACTORS Many factors can affect the adhesion to exercise and sport

classically:

Personal : Physical health factors, Psychological factors

Environmental : Accessibility,..

Informational: Lack of knowledge, Lack of awareness

...And Also:

Related to religious, socio-cultural factors: limiting access to international competition

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BARRIER FACTORS

Exercise and Sport for Persons With Spinal Cord Injury

Kathleen A. Martin Ginis, Sophie Jörgensen,Jessica Stapleton, PM R 2012;4:894-900

Conclusion

Physical activity can have significant physical and psychosocial health benefits for SCI

Health care professionals should be an important source of physical activity information

The promotion and facilitation of physical activity are important to improve well-being and autonomy of SCI

Conclusion In Tunisia, the results of persons with disability in

international competitions are very encouraging

Promoting clinical research training protocols with the constant support of political authorities