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Active Rehabilitation for persons with spinal cord injury in Botswana – effects of a community peer-based programme

Abstract

Study design:

Prospective cohort study with a repeated measures analysis.

Objectives:

To measure the effects of the Active Rehabilitation (AR) training programme for community-dwelling individuals with spinal cord injury (SCI) in Botswana on physical independence, wheelchair mobility, self-efficacy, life satisfaction, level of physical activity and community participation.

Setting:

The inaugural AR training programme in Botswana, a community peer-based programme for people with SCI. The 10-day residential programme in Botswana was led by an international team of peer mentors and health professionals.

Methods:

Participants with SCI (on average 4 years after injury) completed a survey comprising a battery of standardised outcome measures at three timepoints: at the start, on completion and at 5 months after the programme (n = 14). Participants also completed a practical wheelchair skills test at start and completion of the programme (n = 17).

Results:

Participants improved in the mobility subscale of the Spinal Cord Independence Measure Self Report on completion (p = 0.011, d = 0.85) and at 5-month follow-up (p = 0.005, d = 0.93) as compared to baseline. They also achieved moderate improvement in self-efficacy to manage their condition (physical function domain of Moorong Self-Efficacy Scale) and large improvements in wheelchair mobility as assessed through the Queensland Evaluation of Wheelchair Skills test and the Wheelchair Skills Test Questionnaire. All positive results were retained at 5-month follow-up.

Conclusions:

Findings indicate that the peer-based programme AR can play an important role in promoting physical independence, wheelchair mobility and injury-management self-efficacy in community-dwelling individuals with SCI in Botswana.

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References

  1. 1.

    Lofvenmark I, Norrbrink C, Nilsson-Wikmar L, Hultling C, Chakandinakira S, Hasselberg M. Traumatic spinal cord injury in Botswana: characteristics, aetiology and mortality. Spinal Cord. 2015;53:150–4.

  2. 2.

    Lofvenmark I, Hasselberg M, Nilsson Wikmar L, Hultling C, Norrbrink C. Outcomes after acute traumatic spinal cord injury in Botswana: from admission to discharge. Spinal Cord. 2017;55:208–12.

  3. 3.

    Lofvenmark I, Norrbrink C, Nilsson Wikmar L, Lofgren M. ‘The moment I leave my home - there will be massive challenges’: experiences of living with a spinal cord injury in Botswana. Disabil Rehabil. 2016;38:1483–92.

  4. 4.

    Lofvenmark I, Wikmar LN, Hasselberg M, Norrbrink C, Hultling C. Outcomes 2 years after traumatic spinal cord injury in Botswana: a follow-up study. Spinal Cord. 2017;55:285–9.

  5. 5.

    Divanoglou A, Tasiemski T, Augutis M, Trok K. Active Rehabilitation-a community peer-based approach for persons with spinal cord injury: international utilisation of key elements. Spinal Cord. 2017;55:545–52.

  6. 6.

    Divanoglou A, Georgiou M. Perceived effectiveness and mechanisms of community peer-based programmes for Spinal Cord Injuries-a systematic review of qualitative findings. Spinal Cord. 2017;55:225–34.

  7. 7.

    Chaffey L, Bigby C. I Feel Free’: the Experience of a Peer Education Program with Fijians with Spinal Cord Injury. J Dev Phys Disabil. 2018;30:175–88.

  8. 8.

    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335:806–8.

  9. 9.

    Fekete C, Eriks-Hoogland I, Baumberger M, Catz A, Itzkovich M, Luthi H, et al. Development and validation of a self-report version of the Spinal Cord Independence Measure (SCIM III). Spinal Cord. 2013;51:40–7.

  10. 10.

    Gollan EJ, Harvey LA, Simmons J, Adams R, McPhail SM. Development, reliability and validity of the queensland evaluation of wheelchair skills (QEWS). Spinal Cord. 2015;53:743–9.

  11. 11.

    Kirby R, Rushton P, Smith C, Routhier F, Best KL, Cowan R, et al. The wheelchair skills program manual. Halifax, Nova Scotia, Canada: Dalhousie University. https://wheelchairskillsprogram.ca/en/. Accessed Nov 2017.

  12. 12.

    Middleton JW, Tate RL, Geraghty TJ. Self-efficacy and spinal cord injury: psychometric properties of a new scale. Rehabil Psychol. 2003;48:281–8.

  13. 13.

    Middleton JW, Tran Y, Lo C, Craig A. Reexamining the validity and dimensionality of the moorong self-efficacy scale: improving its clinical utility. Arch Phys Med Rehabil. 2016;97:2130–6.

  14. 14.

    Post MW, van Leeuwen CM, van Koppenhagen CF, de Groot S. Validity of the Life Satisfaction questions, the Life Satisfaction Questionnaire, and the Satisfaction With Life Scale in persons with spinal cord injury. Arch Phys Med Rehabil. 2012;93:1832–7.

  15. 15.

    Martin Ginis KA, Phang SH, Latimer AE, Arbour-Nicitopoulos KP. Reliability and validity tests of the leisure time physical activity questionnaire for people with spinal cord injury. Arch Phys Med Rehabil. 2012;93:677–82.

  16. 16.

    Post MW, van der Zee CH, Hennink J, Schafrat CG, Visser-Meily JM, van Berlekom SB. Validity of the utrecht scale for evaluation of rehabilitation-participation. Disabil Rehabil. 2012;34:478–85.

  17. 17.

    Cohen JW Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Hillsdale, NJ: Erlbaum; 1988.

  18. 18.

    Beauchamp MR, Scarlett LJ, Ruissen GR, Connelly CE, McBride CB, Casemore S, et al. Peer mentoring of adults with spinal cord injury: a transformational leadership perspective. Disabil Rehabil. 2016;38:1884–92.

  19. 19.

    Shaw RB, McBride CB, Casemore S, Martin Ginis KA. Transformational mentoring: Leadership behaviors of spinal cord injury peer mentors. Rehabil Psychol. 2018;63:131–40.

  20. 20.

    Chemtob K, Caron JG, Fortier MS, Latimer-Cheung AE, Zelaya W, Sweet SN. Exploring the peer mentorship experiences of adults with spinal cord injury. Rehabil Psychol. 2018;63:542–52.

  21. 21.

    Scivoletto G, Tamburella F, Laurenza L, Molinari M. The spinal cord independence measure: how much change is clinically significant for spinal cord injury subjects. Disabil Rehabil. 2013;35:1808–13.

  22. 22.

    Anderson KD, Acuff ME, Arp BG, Backus D, Chun S, Fisher K, et al. United States (US) multi-center study to assess the validity and reliability of the Spinal Cord Independence Measure (SCIM III). Spinal Cord. 2011;49:880–5.

  23. 23.

    Cijsouw A, Adriaansen JJ, Tepper M, Dijksta CA, van Linden S, de Groot S, et al. Associations between disability-management self-efficacy, participation and life satisfaction in people with long-standing spinal cord injury. Spinal Cord. 2017;55:47–51.

  24. 24.

    Sweet SN, Noreau L, Leblond J, Martin Ginis KA. Peer support need fulfillment among adults with spinal cord injury: relationships with participation, life satisfaction and individual characteristics. Disabil Rehabil. 2016;38:558–65.

  25. 25.

    Conway T. Exploration of the experiences and perceptions of spinal cord injured people who attend outdoor recreation programmes. Dunedin, NZ: University of Otago; 2010. http://hdl.handle.net/10523/626.

  26. 26.

    Kilkens OJ, Post MW, Dallmeijer AJ, van Asbeck FW, van der Woude LH. Relationship between manual wheelchair skill performance and participation of persons with spinal cord injuries 1 year after discharge from inpatient rehabilitation. J Rehabil Res Dev. 2005;42(3Suppl 1):65–73.

  27. 27.

    Worobey LA, Kirby RL, Heinemann AW, Krobot EA, Dyson-Hudson TA, Cowan RE, et al. Effectiveness of group wheelchair skills training for people with spinal cord injury: a randomized controlled trial. Arch Phys Med Rehabil. 2016;97:1777–84.e3.

  28. 28.

    Kirby RL, Mitchell D, Sabharwal S, McCranie M, Nelson AL. Manual wheelchair skills training for community-dwelling veterans with spinal cord injury: a randomized controlled trial. PLoS ONE. 2016;11:e0168330-e.

  29. 29.

    Tu CJ, Liu L, Wang W, Du HP, Wang YM, Xu YB, et al. Effectiveness and safety of wheelchair skills training program in improving the wheelchair skills capacity: a systematic review. Clin Rehabil. 2017;31:1573–82.

  30. 30.

    Divanoglou A, Augutis M, Sveinsson T, Hultling C, Levi R. Self-reported health problems and prioritized goals in community-dwelling individuals with spinal cord injury in Sweden. J Rehabil Med. 2018;10:872–78.

  31. 31.

    Gassaway J, Jones ML, Sweatman WM, Hong M, Anziano P, DeVault K. Effects of Peer mentoring on self-efficacy and hospital readmission after inpatient rehabilitation of individuals with spinal cord injury: a randomized controlled trial. Arch Phys Med Rehabil. 2017;98:1526–34.e2.

  32. 32.

    Mason C, Weber J, Atasoy S, Sabariego C, Cieza A. Development of indicators for monitoring Community-Based Rehabilitation. PLoS ONE. 2017;12:e0178418.

  33. 33.

    World Health Organisation. Community-based rehabilitation (CBR) 2018. https://www.who.int/disabilities/cbr/en/.

  34. 34.

    Ginis K, Nigg C, Smith A. Peer-delivered physical activity interventions: an overlooked opportunity for physical activity promotion. Transl Behav Med. 2013;3:434–43.

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Acknowledgements

We thank all participants, peer mentors and non-disabled members of the team for their involvement in the study. We also thank Inka Lõfvenmark for providing feedback on the manuscript.

Author information

AD is the principal investigator and designed the study in collaboration with TT and SJ. AD conducted the data analysis and prepared the draft of the manuscript. KT was the programme organizer and collected data at follow-up; SJ contributed to data analysis; CH contributed to organising the programme; KS collected data at follow-up; TT collected data at start and completion, and contributed to data analysis. All authors contributed to the design of the study and ethics application. All authors reviewed the manuscript, provided comments and approved final version of the manuscript.

Statement of ethics

The study protocol was reviewed and approved by the Health Research and Development department, Ministry of Health in Botswana (HPDME 13/18/1). We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

Conflict of interest

The authors declare that they have no conflict of interest.

Correspondence to Anestis Divanoglou.

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