Introduction - sbahc.org.sasbahc.org.sa/ISCIC_Sessions_2014/ISCIC_Session3/S3.4 Sofiel SCI... ·...
Transcript of Introduction - sbahc.org.sasbahc.org.sa/ISCIC_Sessions_2014/ISCIC_Session3/S3.4 Sofiel SCI... ·...
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S.GHORBEL-M.GUERMAZI- M.CHEBIL
Physical and Rehabilitation Medicine
King Fahd General Hospital Jeddah
Faculty of Medicine Tunis
Introduction Persons with SCI
Physical aptitude : Reduced
Psychological impact: Anxiety , depression, lack of self-esteem, ….
Social integration: Risk of isolation Aggressiveness or antisocial attitude
Leading to underutilization of real capacities
Physical activity and sport have demonstrated a positive impact on physical aptitude and wellbeing of healthy people
Physical activity is nowadays one of the methods proposed in the rehabilitation of paraplegic patients
What is the real impact in SCI persons??
Introduction Goals
To Assess the effect of regular physical activity on :
Autonomy
Quality of Live QOL
of Tunisian paraplegic Patients
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METHODS
Inclusion criteria Exclusion criteria
T1-L5
Neurologically stable
Mobility on wheel chair
Independently of
Sex / Age
Etiology,
Type : complete or incomplete
TBI
Limb traumatism/ amputation
Psychiatric disorders
Refusal to participate
Case –control Study : 25 subjects
2 GROUPS: 10 athletes, 15 sedentary
The athletes were recruited from the Professional Rehabiltation Center
METHODS
ASSESSMENT
Clinical Status : History / Physical Examination
Functional Status : FIM (Functional Independance Measure)
QOL Status : SF-36 (Medical Outcome Study Short Form 36)
METHODS Clinical Status
Clinical Assessment:
Age /Gender / Duration of paraplegia
Neurological Level (motor/sensitive) : ASIA
Presence of complication (spasticity/contracture/sores...)
Educational Level,profession...
METHODS Functional Status
FIM : Assesses the capacity and autonomy in 6 activities:
Self- care
Sphincter control
Transfer
Locomotion and mobility
Communication
Social integration
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18 items: -13 *motor*: feeding, grooming, bathing, dressing ,toileting, bladder and bowel management, transfer, walking or using wheelchair
-5 *cognition*: comprehension, expression, social interaction, memory and problem solving
Each item is scored from 1 to 7
The score 7 correspond to a total independence
Person is considered dependant if score < 80/126
METHODS Functional Status FIM
METHODS Quality of Life Assessment SF- 36
Assessment of quality of life by the Arabic version of MOS SF-36 (Medical Outcome Study Short Form 36) validated in Arabic
Questionnaire with satisfactory psychometric properties,
METHODS
Quality of Life Assessment SF- 36
36 items divided into 8 dimensions :
1) Physical activity : PF (Physical Functionning)
2) Limitations of physical activity : RP (Role Physical)
3) Pain perception : BP (Bodily Pain)
METHODS Quality of Life Assessment SF- 36
4) Perception of health : GH (General Health)
5) Vitality : VT (Vitality)
6) Social activity : SF (Social functionning)
7) Mental Health : MH (Mental Health)
8) The impact of mental health on daily activities : RE
(Role Emotionnal)
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METHODS
Quality of Life Assessment SF- 36
Two sub-score:
Physical Global Score(PCS) : average PF, RP, BP , GH
Mental Global Score(MCS) : average VT, SF, RE ,MH
Patient responses are present in the form of a profile. A weighted score is calculated for each category. This score ranges from 0 to 100.
Higher score indicating higher level of function and/or better health
RESULTS
RESULTS
p 15 Sedentary 10 Athletes
NS
NS
NS
NS
NS
7,6 (18-43) ±29,13
0,8
D10 L3
ASIA A 11
ASIA C 4
Secondary 11
54,9 (30-228) ±50,9
4 (17-30) ±22,2
0,25
D8 L2
ASIA A 8
ASIA C 2
Secondary 7
19,3 (13-64)±34,5
7,4 ±13,7
2,2 ±4,4
Age
Sex-ratio M/F
Neurologic level
Education
Evolution of the paraplegia(month)
Sport’s activities (month)
Nb Hours/W
RESULTS P Non sportifs Sportifs Moyennes des differents scores
<0,001
0,143
<0,001
0,080
<0,001
0,013
0,533
0,124
0,007
0,004
<0,001
0,052
93,87
6,20
4,13
6,20
3,47
4,13
5,40
5,60
4,8
3,60
3,60
4,73
115,10
7
7
7
7
6,40
5,80
6,60
7
6,30
7
6
Global score
Grooming
Bathing
Dressing upper body
Dressing lower body
Toileting
Bladder management
Bowel management
Transfer bed/chair
Transfer toilet
Transfer bath or shower
Locomotion
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Results Group Athletes Group Sedentary p
Physical Functionning 57.5 ± 14.1 > 49.6 ± 10.6 0.12
Role Physical 27.5 ± 21.8 > 16.6 ± 29.3 0.33
Bodily Pain 52 ± 41.3 > 23 ± 9.2 0.01
General Health 44.6 ± 18.9 > 30.9 ± 24.5 0.14
Vitality 48.2 ± 21.1 > 31.3 ± 19.5 0.04
Social Functionning 47.5 ± 50.6 < 55.3 ± 44.5 0.67
Mental Health 40.6 ± 11.7 > 38 ± 17.6 0.68
Role Emotional 30 ± 48.3 > 20 ± 41.4 0.58
Physical Global Score 45.4 ± 12.4 > 30 ± 13.2 0.008
Mental Global Score 41.5 ± 25.7 > 36.1 ± 18.8 0.54
Discussion
Our study suggests the positive impact of sport on QOL in
paraplegics
- Significant difference in VT, BP and PCS
- Averages of different dimensions of SF-36 are higher in
athletes (except for SF)
Discussion
Physical activity is a factor of improving functional activities
Significant differences : personal care and transfer
For the locomotion no significant differences: negative impact of the architectural barriers and the difficulty of mobility on wheelchair??
Discussion
Encouraging results although : - 4 h / wk training only
- leisure Activity-dependent of the stay in the center
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Discussion Limits of our study:
Size of the population
The impact of certain factors:
socio- economic
spasticity….
Discussion
Discussion Literature Review : 11 STUDIES
Cross sectional :6 studies Interventional :5 studies
Analyze the influence of
physical activities on the QOL
and /or functional
independence , without
performing intervention
Interventional program whith
aerobic activities,
weight training,
gait, or swimming
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Discussion A positive , strong association between physical activity and
Both QOL And Functional Autonomy
The inclusion of both aerobic and resistance exercises
The volume of physical activity > 4 h/week
Discussion The role of exercise and sports:
Physiological Impact:
preventing chronic disease
enhancing physical fitness (capacity, strength, body composition...)
functional performance
Psychological Impact: Overcome his depression
feeling of well being
Restoration of body image and maintaining self-esteem
Social Impact:
Build social relationships through leisure activities with
others, spirit of competition and combativeness
BARRIER FACTORS Many factors can affect the adhesion to exercise and sport
classically:
Personal : Physical health factors, Psychological factors
Environmental : Accessibility,..
Informational: Lack of knowledge, Lack of awareness
...And Also:
Related to religious, socio-cultural factors: limiting access to international competition
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BARRIER FACTORS
Exercise and Sport for Persons With Spinal Cord Injury
Kathleen A. Martin Ginis, Sophie Jörgensen,Jessica Stapleton, PM R 2012;4:894-900
Conclusion
Physical activity can have significant physical and psychosocial health benefits for SCI
Health care professionals should be an important source of physical activity information
The promotion and facilitation of physical activity are important to improve well-being and autonomy of SCI
Conclusion In Tunisia, the results of persons with disability in
international competitions are very encouraging
Promoting clinical research training protocols with the constant support of political authorities