Participant-Reported Benefits of Involvement in an Adaptive Sports Program: A Qualitative Study

A preliminary study on the respiratory benefits of adaptive video gaming in individuals with cervical spinal cord injuries

PURPOSE

The purpose of this study was to collect preliminary data to assess whether participation in adaptive video gaming using a pneumatic sip-and-puff video game controller may provide respiratory or health benefits for individuals with cervical-level spinal cord injuries.

METHODS

A survey was anonymously distributed to potential participants and consisted of four sections: (1) General Information, (2) Gaming Habits, (3) Respiratory Quality of Life, and (4) Impact of Adaptive Video Gaming on Respiratory Health.

RESULTS

The study included 124 individuals with cervical-level spinal cord injuries. Participants had primarily positive self-rated health and good respiratory quality of life. Nearly half of the participants (47.6%) Agreed or Strongly Agreed that their breathing control has improved after using their sip-and-puff gaming controller and 45.2% Agreed or Strongly Agreed that their respiratory health has improved. Individuals who Agreed or Strongly Agreed that adaptive video gaming has improved their breathing control also reported a significantly higher level of exertion while gaming compared to those who did not Agree or Strongly Agree (p = 0.00029).

CONCLUSIONS

It is possible that there are respiratory benefits of using sip-and-puff video game controllers for individuals with cervical spinal cord injuries. The benefits reported by users were found to be dependent on their level of exertion while playing video games. Further exploration in this area is needed due to the positive benefits reported by participants.

Effect of adaptive sports on quality of life in individuals with disabilities who use wheelchairs: a mixed-methods systematic review

PURPOSE

Adaptive sports participation has been shown to improve quality of life (QoL) in individual with disabilities. However, inconsistent results in various domains of QoL exist in the literature. The objective of this mixed-methods systematic review is to identify and synthesize evidence from quantitative and qualitative studies on the effect of adaptive sports on QoL in individuals with disabilities who use wheelchairs for mobility.

METHODS

A systematic literature review of quantitative, qualitative, and mixed-methods research on the effect of adaptive sports on QoL was conducted on five databases (Scopus, Web of Science, PsycINFO, Medline, and PubMed). Quality appraisal was conducted by two authors by using the Mixed Methods Appraisal Tool.

RESULTS

This review identified 4 key findings from 41 studies, including 31 quantitative and 10 qualitative studies. First, individuals with disabilities using wheelchairs for mobility who actively engaged in adaptive sports tend to report higher QoL scores compared with those who were inactive or did not participate. Second, the relationship between the duration of regular participation in adaptive sports and QoL scores exhibited inconsistent results. Third, a multi-component adaptive sports program demonstrates the potential to further improve QoL scores. Last, qualitative investigations reveal that participation in adaptive sports positively influences various domains of well-being in wheelchair users, including encompassing physical and emotional well-being, interpersonal relationships, material well-being, personal development, self-determination, and social inclusion.

CONCLUSION

This review provides a comprehensive relationship between adaptive sports participation and QoL of wheelchair users. This study identifies the value of multi-component interventions and demonstrates the diverse positive influences of adaptive sports on well-being.

Focus areas and methodological characteristics of North American-based health disparity research in sports medicine: a scoping review

OBJECTIVE

Health disparities are widely prevalent; however, little has been done to examine and address their causes and effects in sports and exercise medicine (SEM). We aimed to summarise the focus areas and methodology used for existing North American health disparity research in SEM and to identify gaps in the evidence base.

DESIGN

Scoping review.

DATA SOURCES

Systematic literature search of PubMed, Scopus, SPORTDiscus, CINAHL Plus with Full Text, Web of Science Core Collection and Cochrane Central Register of Controlled Trials.

ELIGIBILITY CRITERIA

Full-text, peer-reviewed manuscripts of primary research, conducted in North America; published in the year 2000 or after, in English; and focusing on organised sports were included.

RESULTS

103 articles met inclusion criteria. Articles were classified into five focus areas: access to and participation in sports (n=45), access to SEM care (n=28), health-related outcomes in SEM (n=24), provider representation in SEM (n=5) and methodology (n=1). Race/ethnicity (n=39), socioeconomic status (n=28) and sex (n=27) were the most studied potential causes of health disparities, whereas sexual orientation (n=5), location (rural/urban/suburban, n=5), education level (n=5), body composition (n=5), gender identity (n=4) and language (n=2) were the least studied. Most articles (n=74) were cross-sectional, conducted on youth (n=55) and originated in the USA (n=90).

CONCLUSION

Health disparity research relevant to SEM in North America is limited. The overall volume and breadth of research required to identify patterns in a heterogeneous sports landscape, which can then be used to inform positive change, need expansion. Intentional research focused on assessing the intersectionality, causes and consequences of health disparities in SEM is necessary.

Influence of adaptive video gaming on quality of life and social relationships

In recent years, the field of adaptive video gaming has been growing rapidly. However, its acceptance as an integral service within the rehabilitation field has been slow to develop and no studies have examined the benefits of providing adaptive gaming services for individuals with disabilities. 110 participants with 6 months or more of adaptive gaming experience took part in a self-administered survey which comprised of questions assessing gaming habits, quality of life, and social relationships. Most participants either Agreed or Strongly Agreed that adaptive gaming has had a significant positive influence on their quality of life (90.9%), satisfaction with life (87.3%), and social relationships (67.2%). Two thirds of participants reported using their adaptive equipment for tasks other than gaming. Individuals who game more often, and with others, had significantly higher Social Relationship scores (p = 0.007; p = 0.044), and gaming frequency had a significant positive correlation with the overall influence of adaptive gaming (p = 0.002). There are possible quality of life and social benefits from participation in adaptive gaming, as well as translation to functional tasks. Furthermore, gaming more frequently, gaming with others, and using adaptive gaming equipment for other tasks seems to correlate with greater benefits from adaptive gaming.

Adaptive sport as affirmation: "We focus on our strengths, not our disabilities"

This paper offers a counter-narrative to the stereotype of people with physical and cognitive impairments being less inclined to participate in athletic activities. It contributes to the affirmative model proposed by Swain and French, which posits a non-tragic view of disability that encompasses positive social identities. We employed the tools of ethnography and phenomenology to explore the adaptive athlete experience among individuals practicing various sports and exhibiting divergent levels of proficiency. Findings confirm the appropriateness of the affirmative model and provide examples of movement from the state of liminality to that of communitas as defined by Victor Turner.

"I never really thought that a virtual ride would be that good!": Experiences of participants with disabilities in online leisure-time physical activity during COVID-19

BACKGROUND

The COVID-19 pandemic has exacerbated the sedentary behavior and inactivity of people, including individuals with disability, who were already less active than their able-bodied counterparts. Therefore, it is particularly important to think about how to maintain and increase their leisure-time physical activity (LTPA). Online adaptive programs may represent a useful tool to do so. However, there is a little research focused on the health impacts of online LTPA.

OBJECTIVE

This mixed-methods study aimed to explore the experiences of people with disabilities who participated in online adaptive LTPA along with the factors contributing to or limiting participation.

METHOD

First, semi-structured interviews were conducted with 10 individuals participating in online adaptive LTPA offered by a community organization. Based on these interviews, a survey was developed and completed by 104 participants.

RESULTS

The results of the study suggested that people with disabilities can get a variety of physical and emotional health benefits when participating in adaptive online LTPA, including a strong social benefit. Staff attitude and knowledge as well as the staff's ability to adapt to participant needs played important roles in facilitating participation. Greater access to equipment was needed.

CONCLUSION

This study offers insights into how online LTPA could support the health-promoting behavior of people with disabilities during the pandemic and beyond.

The demographic and disability characteristics of individuals who regularly attend an urban adaptive fitness center: An observational study

INTRODUCTION

While it is well known that regular physical activity provides significant physical and psychosocial health benefits, people with disabilities have disproportionately lower rates of exercise compared to the able-bodied population. Reduced levels of physical activity can put this population at an increased risk of chronic health conditions, highlighting the importance of ensuring that our communities have accessible adaptive fitness opportunities.

OBJECTIVES

To evaluate the demographic and disability characteristics in individuals who regularly attend a specialized urban adaptive fitness center, to provide foundational understanding about the population that uses such resources.

DESIGN

Cross-sectional study SETTING: Specialized urban adaptive fitness center PARTICIPANTS: Sixty-three (n = 63) participants who regularly attend an urban Adaptive Sports and Fitness Center INTERVENTION: Not applicable MAIN OUTCOME MEASURE: World Health Organization (WHO) Disability Assessment Schedule (WHODAS) 2.0, evaluating disability in six domains: cognition, mobility, self-care, getting along, life activities, and participation. Results were converted into scores ranging from 0 (no disability) to 100 (total disability) and compared to WHO published norms for the general population and a demographics intake form.

RESULTS

Participants with mean age of 52.9 ±14.3 years were grouped into three diagnostic categories: spinal cord injury (30.2%), traumatic brain injury/stroke (36.5%), and other neurologic disease/chronic medical disease (33.3%). A total of 45.9% live alone, 96.8% exercise at least twice/week, and 43.5% participate in adaptive sports. Participants travel 8.0 miles on average for attendance. WHODAS disability summary score was 26.48 (86th percentile).

CONCLUSIONS

Although adaptive fitness center participants had a higher level of disability than 80% to 90% of the general population, regular participation was realistic and feasible. Further understanding of the barriers in those who do not engage in such facilities is needed.

Wheelchair hockey improves quality of life in people with neuromuscular disease

BACKGROUND

Participation in sports is known to have positive effects on people's health and psychosocial well-being. Recently, physical activity implications for people with disabilities have been explored, showing promising results on quality of life and self-concept. However, few studies have specifically investigated the effects of participation in adaptive sports on quality of life in patients with neuromuscular disease.

OBJECTIVE

To evaluate differences in psychosocial well-being between people affected by a neuromuscular disease who play wheelchair hockey and those who do not. Individuals playing an adaptive sport would report better quality of life, higher physical self-efficacy scores, and more effective coping strategies, as assessed by self-reported measures.

DESIGN

Cross-sectional study.

SETTING

Data were collected during clinical follow-ups at the NEMO Clinical Center in Milan (Italy).

PARTICIPANTS

A total of 25 patients affected by neuromuscular diseases, ages 18 to 40 years, participated in the study.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The primary outcome was to compare quality of life between groups. Secondary outcomes were the comparisons of physical self-efficacy and coping strategies through self-reported measures.

RESULTS

Wheelchair hockey players scored significantly higher on the Quality of Life Index (specifically on the health/functioning and psychological/spiritual sub-scales) and reported better physical self-efficacy and perceived physical ability compared to the control group (i.e., patients who do not participate in any adaptive sport), controlling for age and pathology. On the contrary, no difference was found in coping strategies between the two groups.

CONCLUSIONS

This study identified a significant association between participation in wheelchair hockey and improved physical and psychological well-being of people affected by neuromuscular diseases compared to those who are not involved in adaptive sports.

The impact of physical activity on the quality of life of a sample of Italian people with physical disability

Physical activity promotes psychophysical health; however, to date, only few studies have investigated the association between regular physical activity and the quality-of-life perception and satisfaction in disabled persons. Our aim was to compare the quality and satisfaction for life, self-efficacy, and personal wellbeing of two samples of Italian people with physical disability (amputation, spinal cord dysfunction, neurological disability): one group with people who practiced regular physical activity (active group, n = 33) and the other group consisting of sedentary individuals (inactive group, n = 26). We compared the mean scores of the groups in the World Health Organization Quality of Life Questionnaire (WHOQoL-BRIEF), the Personal Wellbeing Index, and the Satisfaction With Life and General Self-Efficacy scales. We also compared the impact of rehabilitation, sport, family support, income, job/school, and raising a family on social life and life quality by means of separate MANOVAs. Results of the WHOQoL showed better quality of life in the active than in the inactive group (overall QOL, 4.09 ± 0.7 vs. 3.50 ± 0.9; psychological domain, 72.09 ± 12.7 vs. 62 ± 21.6; social relationships domain, 76.54 ± 16.4 vs. 59.52 ± 24.2). No difference was found for satisfaction with health and life, personal wellbeing, and self-efficacy. The impact of sport on social life and quality of life was greater in active than in inactive individuals. Findings suggest positive effects of physical activity on the perception of quality of life in disabled people. However, they do not allow disentangling whether physical activity is practiced by patients with good quality of life or whether physical activity is responsible for better quality of life.

The Role of Diets and Dietitians for Para-Athletes: A Pilot Study Based on Interviews

Efforts to provide nutrition support to para-athletes have not been established to date, and are far behind those established for athletes without disabilities. In the present study, we attempted to clarify the actual situation regarding dietary challenges of para-athletes. The aim of this study was to obtain clues to effective intervention methods that encourage the practice of sports nutrition. Six active elite para-athletes (30–70 years, four males) and a female physical therapist without physical disability participated in semi-structured interviews. All para-athletes had lower-limb disabilities and participated in the international wheelchair sports competitions (tennis, softball, and table tennis, with 2–26 years of player history). The interview items were on the ideal diet for improving competitive performance, evaluation of their typical diets, and the role of the dietitian as support. Responses obtained from participants were analyzed using quantitative content analysis by language analysis software. There are differences in the ideal diet based on the characteristics of the sport, but most participants believed that a nutritionally well-balanced diet with abundant vegetables was ideal for improving competitive performance. Para-athletes who use a wheelchair daily pay attention to their total calorie intake, because gaining weight is a critical issue for operating their wheelchairs and transferring themselves to and from their wheelchairs. Despite their world-class competition levels, none of them received routine dietary advice from dietitians. Some para-athletes did not even feel the need to engage with dietitians. Even for these para-athletes at a high level of competition, the “ideal diet” they considered was not always the optimal diet for improving their competitive performance. In addition, there are various barriers to practicing their optimal diet due to disability characteristics. Dietitians need to understand these barriers, their concerns and conflicts, and how to help them plan the optimal diet to improve their performance and maintain overall health.

Self-Assessment of Physical Fitness and Health versus Motivational Value of Physical Activity Goals in People Practicing Fitness, Football, Martial Arts and Wheelchair Rugby

The aim of the study was to determine the relationship between self-assessment of physical fitness and health, and the motivational role of physical activity goals in people, depending on their sports discipline. The study included 470 men and 218 women, aged 18-45, from western and southern Poland. The respondents practiced sports recreationally (fitness-F), competitively (football-FB, martial arts-MA), and for rehabilitation and sports purposes (wheelchair rugby-R). The standardized questionnaire for the motivational role of physical activity goals (Inventory of Physical Activity Objectives, IPAO) by Lipowski and Zaleski and the authors' questionnaire on lifestyle were used. In the statistical analyses, non-parametric statistics were used. Individuals with very high and high self-assessment of their physical fitness and very good self-assessment of health achieved higher scores on the motivational value scale, time management, motivational conflict and multidimensionality of physical activity goals (p < 0.05). Respondents who assessed their health as very good achieved lower results on the perseverance scale, compared to those who assessed their health as good or poor. Self-assessment of physical fitness had a positive, high and moderate correlation with the self-assessment of health in people practicing wheelchair rugby, fitness, football and martial arts (r = 0.61; r = 0.52; r = 0.41; r = 0.40, respectively). Correlations were found between the motivational role and time management in people practicing fitness (r = 0.81), football (r = 0.66) and martial arts (r = 0.45), and multidimensionality of goals in those practicing fitness (r = 0.65) and martial arts (r = 0.42) Wheelchair rugby players scored the highest on all KCAF scales (except for motivational conflict). Self-assessment of physical fitness of wheelchair rugby players and fitness practitioners was negatively correlated with time management (r = -0.68; r = -0.49), multidimensionality of goals (r = -0.51; r = -0.49) and motivational values (r = -0.43; r = -0.43). The demonstrated relationships indicated that there was a need to strengthen the self-esteem and motivation for physical activity, promoting perseverance, the ability to focus on the implementation of one's goals and prioritizing the goals among people practicing various sports disciplines.

Adaptive Sports in Spinal Cord Injury: a Systematic Review

Purpose of Review

Recent Findings

Summary

The Intensity of the Health Behaviors of People Who Practice Wheelchair Basketball, Wheelchair Rugby and Para-Rowing

Sports serve people with disabilities as a form of rehabilitation. Sporting activity is a health-promoting behavior choice and a chance to achieve the best possible sports results. The aim of this study was to evaluate the intensity of health behaviors in people practicing wheelchair basketball, wheelchair rugby and para-rowing. The study encompassed 176 athletes with disabilities, aged 19 to 49 (mean age 34.41 ± 8.56), from all over Poland. Men accounted for 83.5% of the respondents. They all had a significant degree of disability and used wheelchairs in their daily lives. The authors used Juczyński’s Health Behavior Inventory (HBI) and the authors’ own survey questionnaire. Nonparametric tests were used. A greater intensity of health behaviors in general (HBI—point score) and in four categories (correct eating habits—CEH, preventive behaviors—PB, positive mental attitude—PMA, health practices—HP) was observed in rugby and basketball players (compared with para-rowers). Disabled rowers achieved the poorest results. Polish Champions scored better results in preventive behaviors (PB) and weaker results in positive mental attitude (PMA)compared with those practicing amateur sport. Respondents who trained every day and had the longest weekly exercise time (>360 min) achieved the highest results in HBI in general and in all categories compared with those who trained once a week for less than 120 min a week. Respondents with higher education, those in a better financial situation, those who were employed and married, and those who were rural residents displayed a greater intensity of health-related behaviors. People in a more difficult financial situation, who had less education, who were cohabiting, and who lived on only a pension presented more preventive behaviors. There is a need for systemic health education aimed at people with disabilities who practice various sports disciplines.

Community organization factors affecting veteran participation in adaptive sports

Objective: This study aims to describe United States military veteran participation in adaptive sports and to assess the demographic make-up and organizational characteristics of existing adaptive sports programs.Design: Prospective, cross-sectional survey.Setting: Community organizations with adaptive sports programs.Participants: 85 adaptive sports programs.Interventions: Nine question survey.Outcome Measures: Demographic data and sports offered by adaptive sports programs in the United States.Results: The survey response rate was 70%. The median number of total participants in an organization was 75 and the median number of veterans was 50. 76% of organizations had some degree of affiliation with a VAMC. Organizations affiliated with a VAMC are more likely to be rehabilitation centers, whereas community organizations with no VAMC affiliation are most commonly independent organizations with no rehabilitation component. Individuals of all ages participate in adaptive sports, with increasing participation associated with increasing age. Golf was the sport offered most commonly by adaptive sports programs in this survey. Low-contact sports were offered more often than high-contact sports, and the majority of programs offered adaptive sports year-round.Conclusions: Our results suggest that U.S. Military veterans represent a large proportion of the individuals participating in adaptive sports. Further research specifically focusing on factors veterans find desirable when considering participating in adaptive sports is indicated to identify programs that should be promoted, developed, and funded to increase veteran participation in adaptive sports.

Shoulder pain and ultrasound findings: A comparison study of wheelchair athletes, nonathletic wheelchair users, and nonwheelchair users

BACKGROUND

Shoulder pain is one of the most common musculoskeletal concerns in manual wheelchair users including among athletes. However, there is a paucity of research characterizing both shoulder pain and shoulder pathology in this population.

OBJECTIVE

To characterize and compare the prevalence of current shoulder pain and ultrasound metrics of shoulder pathology between wheelchair athletes, nonathletic wheelchair users, and nonwheelchair users.

DESIGN

Cross-sectional.

SETTING

Chicago-area adaptive sport teams/programs and musculoskeletal clinics.

PARTICIPANTS

Thirty-four wheelchair athletes, six nonathletic wheelchair users, and 12 nonwheelchair users.

METHODS

Self-reported shoulder pain was assessed by questionnaire and Wheelchair User Shoulder Pain Index (WUSPI). Shoulder physiology and pathology were assessed by physical and ultrasound evaluation of both shoulders by a sports medicine physician.

MAIN OUTCOME MEASURES

Questionnaire outcomes: Prevalence of current shoulder pain, total WUSPI score. Physical examination outcomes: total Physical Examination of Shoulder Scale (PESS) score. Sonographic outcomes: Acromiohumeral distance (AHD) and presence of shoulder pathology.

RESULTS

The majority of wheelchair athletes (68%) and nonathletic wheelchair users (67%) experienced shoulder pain since using a manual wheelchair. Wheelchair basketball players had a mean WUPSI score of 17.2 (SD = 21.8), and athletes participating in handcycling, sled hockey, and quad rugby had mean scores of 4.91 (SD = 8.32), 7.76 (SD = 13.1), and 4.29 (SD = 7.75), respectively. Shoulder pathology was observed in 14 of 31 (45%) wheelchair athletes and 4 of 6 (67%) nonathletic wheelchair users (p = .41).

CONCLUSIONS

Although wheelchair use is a risk factor for shoulder pain, participation in amateur wheelchair sports may not be associated with increased risk of shoulder pain. It is possible that overhead sports such as wheelchair basketball may define a unique high-risk group. Further study is needed to examine this relationship and to determine whether there are differences between specific wheelchair sports.

Use of Frame Running for Adolescent Athletes With Movement Challenges: Study of Feasibility to Support Health and Participation

Children and adolescents with movement challenges have lower instances of physical activity and longer time spent in sedentary behaviors compared to children with typical development. The purpose of this study was to investigate the feasibility of a sport-based youth development running program modified for accessibility using a running frame and to evaluate initial evidence for its efficacy on endurance and functional strength. We completed four 8-week seasons (2–3 times per week) in a combination of 3 different formats by season: online remote (winter and spring), in person in a community park (winter, spring, and summer), and in person in an afterschool setting (autumn). Participants included 13 athletes (average age 14.46 years, range 8–18 years, 4 females), who collectively completed 22 season blocks. Diagnoses included cerebral palsy (n = 10), arthrogryposis (n = 1), Dandy-Walker malformation (n = 1), and transverse myelitis (n = 1). In all settings, participants engaged in activities of social emotional learning, cardiovascular endurance, and muscle strengthening in a progressive manner. We found that each season format was feasible to administer with high attendance rates (76–97%) and positive qualitative feedback from athletes. In addition, promising average improvements in motor performance across a season (6 min frame running test, 170 m; timed up and go test, 8.44 s; five times sit to stand, 14.1 s; and Goal Attainment Scale, t = 65.01) were identified in the pilot data of this non-randomized cohort. Training in any of the proposed settings with an overall goal of completing a community race in a running frame is feasible and warrants further study.

Prevalence of lateral epicondylosis in veteran manual wheelchair users participating in adaptive sports

Objective: Determine the prevalence of lateral epicondylosis (LE) of the dominant elbow in manual wheelchair users based on ultrasound assessment and physical exam.Design: Prospective, cross-sectional.Setting: National Veteran Wheelchair Games 2018 and 2019 (event medical services).Participants: Manual wheelchair users who attended the National Veteran Wheelchair Games (n = 87).Interventions: Participants completed a questionnaire then underwent an ultrasound assessment and a physical exam of their dominant arm evaluating for common extensor tendinopathy (CET) or clinically LE.Main Outcome Measure: Prevalence of CET diagnosed by ultrasound criteria was compared with other diagnostic criteria with MaNemar test for paired binary data.Results: Forty-six percent (N = 40) of participants met diagnostic criteria for CET by ultrasound assessment and 17% (N = 15) of participants met criteria for LE based on physical exam. These values are dramatically higher than what has been reported in the able-bodied population where the prevalence is estimated to be <2%. Age and number of years of wheelchair use were significant predictors of ultrasound diagnosis of LE (P = 0.02, 95% confidence interval [CI] 1.01-1.11) and (P = 0.05, 95% CI 1.00-1.09), respectively. Association analysis based on odds ratio and CI found no association between ultrasound findings suggestive of LE with regular adaptive sport participation greater than 1.5 h per week.Conclusion: Compared to able-bodied population, there is an increased prevalence of both CET and LE in manual wheelchair users based on either ultrasound assessment or physical exam. CET is associated with increased age and increased years using a manual wheelchair. There is no association between the diagnosis of LE and participation in adaptive sport.

Exploring well-being services from the perspective of people with SCI: A scoping review of qualitative research

Objective

Well-being after spinal cord injury is affected by a range of factors, many of which are within the influence of rehabilitation services. Although improving well-being is a key aim of rehabilitation, the literature does not provide a clear path to service providers who seek to improve well-being. This study aimed to inform service design by identifying the experience and perspective of people with SCI about interventions targeting their well-being.

Method

The scoping review of qualitative literature used thematic analysis to identify and categorize themes related to service activities, valued aspects, limitations and perceived outcomes.

Results

Thirty-eight studies were selected, related to a range of service types. Most studies did not adopt a well-being conceptual framework to design and evaluate the services. People with SCI particularly valued being treated with dignity, positive expectations, increased autonomy and peer support. Improvements to well-being were reported, including many years post-SCI. However, people with SCI reported limited opportunities to engage in such services.

Conclusions

Rehabilitation services can improve well-being across the lifetime of people with SCI, but gaps in service provision are reported. The review identified valued aspects of services that may inform service design, including staff approach and positive expectations, having own skills and worth valued, peer support and interaction, autonomy in valued occupations, and long-term opportunities for gains.

Building a virtual summer research experience in cancer for high school and early undergraduate students: lessons from the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic posed a unique challenge for summer research programs in 2020, particularly for programs aimed at hands-on experience for younger trainees. The Indiana University Melvin and Bren Simon Comprehensive Cancer Center supports two pipeline programs, which traditionally immerse high school juniors, seniors, and early undergraduate students from underrepresented populations in science in hands-on projects in cancer biology labs. However, due to social distancing policies during the pandemic and reduction of research operations, these students were not physically allowed on campus. Thus, the authors set out to strategically pivot to a wholly virtual curriculum and evaluate the Virtual Summer Research Experience in Cancer outcomes.

METHODS

The virtual program included four components: 1. a core science and professional development curriculum led by high school teachers and senior undergraduates; 2. faculty-delivered didactic sessions on cancer science; 3. mentored, virtual research projects with research faculty; and 4. online networking events to encourage vertical mentoring. Outcomes data were measured using a locally created 11-item Research Preparation Scale, daily electronic feedback, and weekly structured evaluation and feedback via Zoom.

RESULTS

Outcome data suggested high self-reported satisfaction with the virtual program. Outcome data also revealed the importance of coordination between multiple entities for seamless program implementation. This includes the active recruitment and participation of high school teachers and further investment in information technology capabilities of institutions.

CONCLUSIONS

Findings reveal a path to educate and train high school and early undergraduate students in cancer research when hands-on, in-person training is not feasible. Virtual research experiences are not only useful to engage students during public health crises but can provide an avenue for cancer centers to expand their cancer education footprints to remotely located schools and universities with limited resources to provide such experiences to their students.

Qualitative Analyses of the Reasons Why Patients Do Not Attend Scheduled Inpatient Appointments in a Hospital in Guangzhou, China

Purpose

Exploration of the reasons why people miss scheduled inpatient appointments from the perspectives of patients.

Methods

Semi-structured interviews via telephone were conducted with patients who missed their inpatient appointments. Data were analyzed based on Colaizzi’s seven-step method.

Results

Twenty-five patients and five dependents were enrolled. Three themes were identified: practical barriers, lack of knowledge about the disease, and negative emotional responses. Personal social obligations, state of illness, financial issues and long waiting times were the main practical barriers preventing patients from attending their inpatient appointment. Patients’ perceptions of feasible self-solving symptoms, readily believing people around them, and a blindly optimistic attitude towards disease contributed to their insufficient knowledge about the disease. Negative emotional responses (eg, sense of fear and lack of trust in physicians) had a detrimental effect on inpatient attendance.

Conclusion

Three main factors contributed to non-attendance of inpatient appointments: practical barriers, lack of knowledge about disease, and negative emotional response. Our study provides new, valuable evidence on non-attendance of inpatient appointments in China. Our findings could offer meaningful insights into developing effective strategies to reduce non-attendance of inpatient appointments in other countries.

Patient experiences of decision-making in the treatment of spinal metastases: a qualitative study

BACKGROUND

In the treatment of spinal metastases the risks of surgery must be balanced against potential benefits, particularly in light of limited life-expectancy. Patient experiences and preferences regarding decision-making in this context are not well explored.

PURPOSE

We performed a qualitative study involving patients receiving treatment for spinal metastatic disease. We sought to understand factors that influenced decision-making around care for spinal metastases.

STUDY SETTING

Three tertiary academic medical centers.

PATIENT SAMPLE

We recruited patients presenting for treatment of spinal metastatic disease at one of three tertiary centers in Boston, MA.

OUTCOME MEASURES

We conducted semistructured interviews using a guide that probed participants' experiences with making treatment decisions.

METHODS

We performed a thematic analysis that produced a list of themes, subthemes, and statement explaining how the themes related to the study's guiding questions. Patients were recruited until thematic saturation was reached.

RESULTS

We interviewed 23 participants before reaching thematic saturation. The enormity of treatment decisions, and of the diagnosis of spinal metastases itself, shaped participant preferences for who should take responsibility for the decision and whether to accept treatments bearing greater risk of complications. Pre-existing participant beliefs about decision-making and about surgery interacted with the clinical context in a way that tended to promote accepting physician recommendations and delaying or avoiding surgery.

CONCLUSIONS

The diagnosis of spinal metastatic disease played an outsized role in shaping participant preferences for agency in treatment decision-making. Further research should address strategies to support patient understanding of treatment options in clinical contexts-such as spinal metastases-characterized by ominous underlying disease and high-risk, often urgent interventions.

Psychosocial impact of sport activity in neuromuscular disorders

Previous studies demonstrated the benefits of motor exercise and physical activity in neuromuscular disorders. However, very few papers assessed the effects of sport practise. The aim of this multicentre study was to assess the impact of sport activity on self-esteem and emotional regulation in a cohort of athletes with neuromuscular disorders. The 38 patients with Duchenne, Becker or other types of muscular dystrophy or spinal muscular atrophy practising sport (aged 13-49 years) and 39 age-, gender-, disability- and disease-matched patients not practising sport were enrolled. Testing procedures to assess self-esteem, anxiety and depression disorder, personality trait and quality of life (QoL) were used. Patients practising sport had a significantly higher self-esteem, lower level of depression, greater social own identity and adherence and QoL. Frequency of sport activity may represent a complementary therapy in neuromuscular disorders to improve mental and social well-being.

Winter Adaptive Sports Participation, Injuries, and Equipment

As the participation rate and popularity of winter adaptive sports increases, understanding injury patterns and equipment is crucial for athletes, coaches, athletic trainers, sports physicians, prosthetists/orthotists, and all the staff involved. While the inaugural Winter Paralympics in 1976 had 17 participating countries, the most recent paralympic games in Pyeongchang, South Korea had >500 athletes from 49 different countries competing in 6 disciplines: alpine skiing, nordic skiing, sledge hockey, wheelchair curling, biathlon, and snowboarding. In this paper, we review participation rates, injury trends and equipment, with a focus on the 3 most popular events: alpine skiing, nordic skiing, and sledge hockey. Despite injury risk within this athletic community, there are documented advantages to physical movement, and for each individual the risks of injury have to be weighted with the benefits of competing. Overall, there is a need for educational efforts regarding the development, access, and participation to injury prevention programs with an integrated and multidisciplinary approach.

Shoulder Pain and the Weight-bearing Shoulder in the Wheelchair Athlete

Shoulder pain is one of the most common complaints amongst wheelchair athletes. There are many debated potential risk factors for shoulder pain in this population including inherent anatomy, increased loading forces, overuse, age, wheelchair use duration, trunk control, and sport played. Proper identification of etiology of shoulder pain with a thorough history and physical examination is important for management purposes. Treatment can be challenging as complete rest from exacerbating activities is often difficult as upper extremity use is necessary for everyday life activities such as mobility and transfers. Addition of shoulder maintenance strengthening program focusing on strengthening adductors, external rotators, and scapular retractors is important to keep shoulder muscles well-balanced to prevent injury.

A Descriptive Study of Self-Reported Injury in Non-elite Adaptive Athletes

BACKGROUND

Adaptive sports programs are increasing across the country and there is a paucity of research investigating the epidemiology and sports injury risk factors in non-elite athletes.

OBJECTIVE

To assess the demographics, training regime, and injuries incurred by adaptive athletes participating in local adaptive sports clubs and to assess the athletes' type of medical care and prevalence of those with spasticity.

DESIGN

Descriptive cross-sectional study.

SETTING

Local area adaptive sports teams and programs.

PARTICIPANTS

Sixty-one athletes participating in wheelchair basketball, wheelchair rugby, sled hockey, and adaptive rowing were surveyed, with a response rate of 70.5%.

INTERVENTIONS

Completion of self-report survey.

OUTCOME

Report of injury prevalence, injury characteristics, type of medical care, and assessment of frequency and severity of spasticity using the Penn Spasm Frequency Scale.

RESULTS

Most athletes (86%) trained or competed in their main sport 9-12 months per year. Most athletes (79.1%) trained at least 4 hours per week. In the past 12 months, 39.5% of athletes surveyed sustained an injury that required them to miss practice or a competition, with 58.8% of these athletes having sustained a significant injury. Many of those injured (64.7%) had never participated in an injury prevention or conditioning program. Injury prevalence by sport was 42.9% in wheelchair rugby, 60% in sled hockey, 44% wheelchair basketball, and 0% in adaptive rowing. The most commonly injured body parts were the shoulder (52.9%) and wrist (52.9%).

CONCLUSIONS

This study shows that non-elite adaptive sports athletes sustain similar types of injuries as noted in published reports of elite athletes but could be provided with less injury prevention education and access to medical care. This area will require future study, especially investigating injury risk factors within specific sports and diagnoses.

LEVEL OF EVIDENCE

III.