Effectiveness of the ProACTIVE SCI Intervention on Physical Activity and Psychosocial Outcomes During the Transition From Rehabilitation to Community Among Adults With Spinal Cord Injury: A Pre-Post Trial.

Abstract

To evaluate the effectiveness of the ProACTIVE SCI intervention on physical activity (PA) behavior and psychosocial predictors among people with spinal cord injury (SCI). Pre-post trial. Community. Twenty-eight participants (N=28) with SCI (19 men and 9 women, 50±14y). One-year PA coaching after discharge from rehabilitation provided by SCI-peers. Primary outcome measure was minutes and days engaged in aerobic and strength-training PA over a 7-day recall period. Secondary outcome measures included psychosocial outcome measures and a semistructured interview that explored effects of the intervention on physical and mental health, intervention satisfaction, and satisfaction with life. Time engaged in aerobic PA was maintained from baseline to both 6-months and 1-year post discharge (all P>.23). The d/wk of strength-training moderate-to-vigorous PA (MVPA) increased from baseline to 6-month (2.1±2.7 vs 4.0±2.7d/wk, d=0.70, P<.01) and 1-year postdischarge (3.0±2.5d/wk, d=0.35, P=.54) (main effect P=.03) as did the percentage of participants meeting SCI-specific strength-training PA guidelines (P=.029). There were no statistically significant changes in psychosocial outcomes; however, there were moderate-sized effects for increased strength exercise task self-efficacy and self-monitoring at both 6-months and 1-year postdischarge (d=0.42-0.56). Analysis of semistructured interviews revealed 4 themes regarding PA coaching after discharge from rehabilitation: physical health, mental health, sense of community, and time. Participants reported high levels of satisfaction with the program (5.5±0.68 on a 6-point scale). We explored the effectiveness of SCI peer-led PA coaching after discharge from rehabilitation in individuals with SCI-which is typically associated with reduced PA participation. Aerobic MVPA participation was maintained for 1-year, and strength-training MVPA participation significantly increased at 6-months postdischarge. These findings are important as they describe an effective strategy for maintaining PA during the transition from rehabilitation to the community-living in individuals with SCI.