Adherence to prescriptions of therapeutic exercises in patients with traumatic spinal cord injury
More details
Hide details
Medical University, Warsaw, Poland
National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
Mazovian Rehabilitation Center STOCER, Konstancin-Jeziorna, Poland
Justyna Frasuńska   

Medical University of Warsaw, Poland
Spinal cord injury (SCI), which disrupts motor, sensory and autonomic functions, causes significant changes in the functioning of an individual. It is believed that most of the conditions secondary to SCI, i.e. osteoporosis, spasticity or cardiopulmonary diseases, are associated with immobility. The aim of the study is to assess the adherence to prescriptions of therapeutic exercises (APTE) in patients with SCI after acute phases of rehabilitation.

Material and methods:
The criterionfor APTE recognition was the performance at least twice a week for a minimum of 30 minutes of active exercises with resistance, and exercises maintaining the range of movement of the joints The research tools were own questionnaire and the WHOQOL-BREF scale.

46 subjects (63.9%) met the APTE criteria. The most frequent place for performing the exercises was the subject’s home with 43 subjects (93.5%) with APTE performed the exercises in their homes. 17 subjects (36.9%) with APTE performed exercises during stays at various rehabilitation centres. The main cause for the lack of APTE was the limited availability of facilities considered necessary by the respondents to adhere to the instructions. In statistical analysis, the level of neurological injury correlated with meeting the APTE criteria. It was discovered that a subjective assessment of the exercise dose correlated with the place where the exercises were performed, but did not correlate with meeting the APTE criteria.

The basic place for performing exercises (as instructed in hospital) was the subject’s home. Limited access to reimbursed environmental therapy resulted in an increased cost of exercises supervised by commercially-employed physiotherapists. The current gaps in the system of supervision and counselling of subjects post-SCI necessitate changes in the Polish health care system.

Sweis R, Biller J. Systemic Complications of Spinal Cord Injury. Curr Neurol Neurosci Rep. 2017; 17: 1–8.
Rapidi CA, Tederko P, Moslavac S, Popa D, Branco CA, Kiekens C et. al. Professional Practice Committee of the UEMS-PRM Section. Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for persons with spinal cord injury. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med. 2018; 54: 797–807.
Skelton F, Hoffman JM , Reyes M, Examining health-care utilization in the first year following spinal cord injury. J Spinal Cord Med. 2015; 38: 690–695.
Jensen MP, Molton IR, Groah SL, Cmapbell ML, Charilifue S, Chiodo A, et al. Secondary health conditions in individuals aging with SCI: terminology, concepts and analytic approaches. Spinal Cord. 2012; 50: 373–378.
Hayden JA, van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Inter Med. 2005; 142: 776–785.
Campbell R, Evans M, Tucker M, Quilty B, Dieppe P, Donovan J. Why don’t patients do their exercises? understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee. J Epidemiol Community Health. 2001; 55: 132–138.
Friedrich M, Gittler G, Halberstadt Y, Cermak T, Heiller I. Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil. 1998; 79: 475–487.
Harvey LA. Physiotherapy rehabilitation for people with spinal cord injuries. J Physiother. 2016; 62(1): 4–11.
Zbogar D, Eng JJ, Miller WC, Krassioukov AV, Verrier MC. Movement repetitions in physical and occupational therapy during spinal cord injury rehabilitation. Spinal Cord. 2017; 55(2): 172–179.
Scivoletto G, Miscusi M, Forcato S, et al. The Rehabilitation of Spinal Cord Injury Patients in Europe. Acta Neurochir Suppl. 2017; 124: 203–210.
Côté MP, Murray M, Lemay MA. Rehabilitation Strategies after Spinal Cord Injury: Inquiry into the Mechanisms of Success and Failure. J Neurotrauma. 2017; 34(10): 1841–1857.
Evans N, Wingo B, Sasso E, Hicks A, Gorgey AS, Harness E. Exercise Recommendations and Considerations for Persons With Spinal Cord Injury. Arch Phys Med Rehabil. 2015; 96: 1749–1750.
Sluijs EM, Knibbe JJ. Patient Compliance with Exercise: Different Theoretical Approaches to Short-Term and Long-Term Compliance, Patient Educ Couns. 1991; 11: 191–204.
Sabate E. Adherence to Long Term Therapies – Evidence for Action. (Geneva. World Health Organisation 2003 WHO/NLM/W85).
Jack K, McLean SM, Moffett JK, Gardiner E. Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review. Man Ther. 2010; 15: 220–228.
Pelletier CA, Latimer-Cheung AE, Warburton DE, Hicks AL. Direct referral and physical activity counselling upon discharge from spinal cord injury rehabilitation. Spinal Cord. 2014; 52: 392–395.
Pelletier CA, Totosy de Zepentnek JO, MacDonald MJ, Hicks AL. A 16-week randomized controlled trial evaluating the physical activity guidelines for adults with spinal cord injury. Spinal Cord. 2015, 53: 363–367.
Dolbow DR, Gorgey AS, Ketchum JM, Moore JR, Hackett LA, Gater DR. Exercise adherence during home-based functional electrical stimulation cycling by individuals with spinal cord injury. Am J Phys Med Rehabil. 2012; 91: 922–930.
Hicks AL, Martin KA, Ditor DS, Latimer AE, Craven C, Bugaresti J et al. Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being. Spinal Cord. 2003; 41: 34–43.
Ditor DS, Latimer AE, Ginis KA, Arbour KP, McCartney N, Hicks AL. Maintenance of exercise participation in individuals with spinal cord injury: effects on quality of life, stress and pain. Spinal Cord. 2003; 41: 446–450.
Dietz V, Fouad K. Restoration of sensorimotor functions after spinal cord injury. Brain. 2014; 137(3): 654–67.
Wołowicka L. Przegląd badań nad jakością życia chorych po intensywnej terapii dorosłych. In: Wołowicka L. (eds.) Jakość życia w naukach medycznych. (Wyd. UM Poznań. 2001), 193–201.
Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud., 1988; 2: 61–63.
Opara J, Mehlich K., Bielecka A. Walking index for spinal cord injury. Ortop Traumatol Rehabil. 2007; 9: 122–127.
Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, Johansen M et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011: 34: 535–546.
Ginis KAM, Hicks AL, Latimer AE, Warburton DER, Bourne C, Ditor DS et al. The development of evidence-informed physical activity guidelines for adults with spinal cord injury. Spinal Cord. 2011; 49: 1088–1096.
Tederko P, Jagodziński R, Krasuski M, Tarnacka B. People with spinal cord injury in Poland. Am J Phys Med Rehabil. 2017; 96: 102–105.
Vissers M, van den Berg-Emons R, Sluis T, Bergen M, Stam H, Bussman H. Barriers to and facilitators of everyday physical activity in persons with a spinal cord injury after discharge from the rehabilitation centre. J Rehabil Med. 2008; 40: 461–467.
Scelza WM, Kirshblum SC, Wuermser LA, Ho CH, Priebe MM, Chiodo AE. Community reintegration after spinal cord injury. Spinal cord injury medicine. 4. Community reintegration after spinal cord injury. Arch Phys Med. Rehabil. 2007; 88: 71–75.
Tederko P, Mycielski J, Angerova Y, et al. Role of diversity in assembling of rehabilitation teams in Central Europe [published online ahead of print, 2020 Jan 14]. Eur J Phys Rehabil Med. 2020;10.23736/S1973–9087.20.05904–3. doi:10.23736/S1973–9087.20.05904–3.
Anneken V, Hanssen-Doose A, Hirschfeld S, Scheuer T, Thietje R. Influence of physical exercise on quality of life in individuals with spinal cord injury. Spinal Cord. 2010; 48: 393–399.
Minister of Health’s Notice of 30 January 2018 on publication of the consolidated text of the Regulation of the Minister of Health on guaranteed benefits in the field of therapeutic rehabilitation, Polish Journal of Laws Dz.U.2018, item 465,.
Kuret Z, Burger H, Vidmar G, Maver T. Adjustment to finger amputation and silicone finger prosthesis use. Disabil Rehabil. 2019; 41(11): 1307–1312.
Robins JMW, Boyle A, McCune K, Lodh R, Goodden JR. Quality of life after selective dorsal rhizotomy: an assessment of family-reported outcomes using the CPQoL questionnaire published online ahead of print, 2020 Feb 24]. Childs Nerv Syst. 2020; 10.1007/s00381–020–04546–1.
Schmidberger J, Steinbach J, Schlingeloff P, Kratzer W, Grüner B. Surgery versus conservative drug therapy in alveolar echinococcosis patients in Germany – A health-related quality of life comparison. Food Waterborne Parasitol. 2019; 16: e00057. Published 2019 May 30. doi:10.1016/j.fawpar.2019.e00057.