title: A behavioural intervention increases physical activity in people with subacute spinal cord injury: a randomised trial.
abstract: OBJECTIVE
  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?
  
  
  METHODS
  Randomised, controlled trial with concealed allocation, intention-to-treat analysis, and blinded assessors.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The behavioural intervention was effective in eliciting a behavioural change toward a more active lifestyle among people with subacute spinal cord injury.
  
  
  BACKGROUND
  NTR2424.
authors.affiliation: Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam.
authors.forename: Carla Fj
authors.initials: CF
authors.lastname: Nooijen
authors.affiliation: Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam.
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Stam
authors.affiliation: Rijndam Rehabilitation Institute, Rotterdam.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Bergen
authors.affiliation: Adelante Center of Expertise in Rehabilitation and Audiology, Hoensbroek.
authors.forename: Helma Mh
authors.initials: HM
authors.lastname: Bongers-Janssen
authors.affiliation: Heliomare Rehabilitation Center, Wijk aan Zee.
authors.forename: Linda
authors.initials: L
authors.lastname: Valent
authors.affiliation: Rehabilitation Center De Hoogstraat, Utrecht.
authors.forename: Sacha
authors.initials: S
authors.lastname: van Langeveld
authors.affiliation: Department of Epidemiology & Biostatistics, VU University Medical Center; Department of Health Sciences, VU University, Amsterdam, The Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: Twisk
authors.affiliation: Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam.
authors.forename: Rita Jg
authors.initials: RJ
authors.lastname: van den Berg-Emons
mesh_terms: D061725:Accelerometry; D000328:Adult; D001521:Behavior Therapy; D015444:Exercise / Q000523:psychology*; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000523:psychology / Q000534:rehabilitation*; D016896:Treatment Outcome
keywords: Behaviour modification; Motor activity; Physical activity; Physical therapy; Spinal cord injury