title: Patterns of changes in wheelchair exercise capacity after spinal cord injury.
abstract: OBJECTIVE
  (1) To identify different patterns of changes in wheelchair exercise capacity in the period between the start of active spinal cord injury (SCI) rehabilitation and 5 years after discharge; (2) to examine the pattern determinants of the change in wheelchair exercise capacity.
  
  
  METHODS
  Prospective cohort study. Measurements were recorded at the start of active inpatient rehabilitation, 3 months after the start, at discharge of inpatient rehabilitation, 1 year after discharge, and 5 years after discharge.
  
  
  METHODS
  Eight rehabilitation centers.
  
  
  METHODS
  Persons with SCI (N=130; age range, 18-65y), who were wheelchair-dependent, at least for long distances.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Wheelchair exercise capacity: peak power output (W).
  
  
  RESULTS
  We found 4 different patterns of the change of peak power output (mean ± SD): (1) a pattern with high and progressive scores (33% of total study group): high progressive scores (start of rehabilitation: 49±15W to 5 years after discharge: 77±17.2W); (2) a pattern of improvement during inpatient rehabilitation and deterioration after inpatient rehabilitation (12%): progressive scores during inpatient rehabilitation with deteriorating scores after discharge (start of rehabilitation: 29±8.7W, to discharge: 60±8.4W, to 5 years after discharge: 39±13.1W); (3) a pattern with low and only slightly progressive scores (52%): low progressive scores (start of rehabilitation: 20±10.1W to 5 years after discharge: 31±15.9W); and (4) a pattern with low scores during inpatient rehabilitation and a sharp rise after discharge (3%): low inpatient scores with strong progressive scores after discharge (start of rehabilitation: 29±15.5W to 5 years after discharge: 82±10.6W). A logistic regression of factors that may distinguish between patterns with high and progressive scores and patterns with low and only slightly progressive scores revealed that older age, being a woman, having a tetraplegic lesion, and low functional status were associated with patterns with low and only slightly progressive scores. The pattern of improvement during inpatient rehabilitation and deterioration after inpatient rehabilitation showed more neuropathic pain and lower sports participation than patterns with high and progressive scores.
  
  
  CONCLUSIONS
  For the vast majority of patients, wheelchair exercise capacity after SCI shows a positive trend and can be described in distinct patterns that are dependent on personal, lesion, and functional characteristics.
authors.affiliation: Department of Rehabilitation Medicine and Rudolf Magnus Institute for Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands. c.v.koppenhagen@dehoogstraat.nl
authors.forename: Casper F
authors.initials: CF
authors.lastname: van Koppenhagen
authors.forename: Sonja
authors.initials: S
authors.lastname: de Groot
authors.forename: Marcel W
authors.initials: MW
authors.lastname: Post
authors.forename: Trynke
authors.initials: T
authors.lastname: Hoekstra
authors.forename: Floris W
authors.initials: FW
authors.lastname: van Asbeck
authors.forename: Helma
authors.initials: H
authors.lastname: Bongers
authors.forename: Eline
authors.initials: E
authors.lastname: Lindeman
authors.forename: Luc H
authors.initials: LH
authors.lastname: van der Woude
mesh_terms: D000328:Adult; D000367:Age Factors; D001827:Body Height; D015992:Body Mass Index; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006304:Health Status; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D010351:Patient Discharge; D011446:Prospective Studies; D012737:Sex Factors; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000534:rehabilitation*; D013177:Sports; D013997:Time Factors; D015599:Trauma Severity Indices; D014910:Wheelchairs