Life satisfaction and wheelchair exercise capacity in the first years after spinal cord injury

Abstract

In Chapter 1 an overview was given of the research context of this thesis. The health condition spinal cord injury and its accompanying health complications were described The results of Chapter 2 showed a marked decrease in life satisfaction of persons with spinal cord injury at one year after discharge from inpatient rehabilitation, compared to the general population and to their own life satisfaction before spinal cord injury. Decrease of life satisfaction was strongest for the domains Sexual life, Self care and Vocational situation. Partner relations, Family life and Contacts with friends and acquaintances appeared the least affected life domains. Age, gender and education had little influence on life satisfaction after spinal cord injury or change of life satisfaction. High level of lesion, suffering from pain and from secondary impairments were associated with a decrease of life satisfaction and with low life satisfaction one year after discharge. The results of Chapter 3 showed that life satisfaction improved during inpatient rehabilitation, especially during the first 3 months of active rehabilitation and remained stable during the first year after discharge. Having few pain sensations and a low number of other secondary impairments and having a better functional status were predictors of a more favourable course of life satisfaction early after spinal cord injury. Our results in Chapter 4 were showed that no significant changes in mean wheelchair exercise capacity were found between discharge and five years later. No significant determinants for the course of wheelchair exercise capacity in the one to five year interval were detected. Again age, gender, level and completeness of lesion were determinants for peak oxygen uptake and level of lesion and gender for peak power output, a confirmation of other international studies. The loss to follow up-group was older of age and included more persons with tetraplegia, probably leading to a slight overestimation of the model outcome for wheelchair exercise capacity. Chapter 5 confirmed that different wheelchair exercise capacity trajectories exist after spinal cord injury.. We found four different trajectories in the course of peak power output: 1) high progressive scores; 2) deteriorating scores: progressive scores during inpatient rehabilitation with deteriorating figures after discharge; 3) low progressive scores: low scores at start of rehabilitation with relative strong progressive scores after discharge; and 4) low inpatient scores with very strong progressive scores after discharge. Logistic regression of factors that might be distinctive between the trajectories with high progressive scores and low progressive scores, revealed that older age, female gender, tetraplegic lesion and low functional status were associated with the class with low progressive scores. In Chapter 6 we examined that wheelchair exercise capacity and life satisfaction in spinal cord injury population are longitudinally associated up to five years after discharge of inpatient rehabilitation. Further analyses revealed that the relationship between exercise capacity and life satisfaction was mainly based on the within-subject variance, suggesting that improvement of physical fitness might lead to improvement of life satisfaction Finally, Chapter 7 summarized the general aim and main findings of this study.