OBJECTIVES:

To describe the incidence of injury in the precompetition and competition periods of the Rio 2016 Summer Paralympic Games.

METHODS:

A total of 3657 athletes from 78 countries, representing 83.4% of all athletes at the Games, were monitored on the web-based injury and illness surveillance system over 51 198 athlete days during the Rio 2016 Summer Paralympic Games. Injury data were obtained daily from teams with their own medical support.

RESULTS:

A total of 510 injuries were reported during the 14-day Games period, with an injury incidence rate (IR) of 10.0 injuries per 1000 athlete days (12.1% of all athletes surveyed). The highest IRs were reported for football 5-a-side (22.5), judo (15.5) and football 7-a-side (15.3) compared with other sports (p<0.05). Precompetition injuries were significantly higher than in the competition period (risk ratio: 1.40, p<0.05), and acute traumatic injuries were the most common injuries at the Games (IR of 5.5). The shoulder was the most common anatomical area affected by injury (IR of 1.8).

CONCLUSION:

The data from this study indicate that (1) IRs were lower than those reported for the London 2012 Summer Paralympic Games, (2) the sports of football 5-a-side, judo and football 7-a-side were independent risk factors for injury, (3) precompetition injuries had a higher IR than competition period injuries, (4) injuries to the shoulder were the most common. These results would allow for comparative data to be collected at future editions of the Games and can be used to inform injury prevention programmes.

Objective

To evaluate the psychometric properties of the Fatigue Severity Scale (FSS), the Fatigue Impact Scale (FIS), and the Multidimensional Fatigue Inventory (MFI-20) in persons with late effects of polio (LEoP). More specifically, we explored the data completeness, scaling assumptions, targeting, reliability, and convergent validity.

Methods

A postal survey including FSS, FIS, and MFI-20 was administered to 77 persons with LEoP. Responders received a second survey after 3 weeks to enable test-retest reliability analyses.

Results

Sixty-one persons (mean age, 68 years; 54% women) responded to the survey (response rate 79%). Data quality of the rating scales was high (with 0%–0.5% missing item responses), the corrected item-total correlations exceeded 0.4 and the scales showed very little floor or ceiling effects (0%–6.6%). All scales had an acceptable reliability (Cronbach’s α ≥0.95) and test-retest reliability (intraclass correlation coefficient, ≥0.80). The standard error of measurement and the smallest detectable difference were 7%–10% and 20%–28% of the possible scoring range. All three scales were highly correlated (Spearman’s correlation coefficient r_s=0.79–0.80; p<0.001).

Conclusion

The FSS, FIS, and MFI-20 exhibit sound psychometric properties in terms of data completeness, scaling assumptions, targeting, reliability, and convergent validity, suggesting that these three rating scales can be used to assess fatigue in persons with LEoP. As FSS has fewer items and therefore is less time consuming it may be the preferred scale. However, the choice of scale depends on the research question and the study design.

OBJECTIVE:

To describe the epidemiology of illness at the Rio 2016 Summer Paralympic Games.

METHODS:

A total of 3657 athletes from 78 countries, representing 83.5% of all athletes at the Games, were monitored on the web-based injury and illness surveillance system (WEB-IISS) over 51 198 athlete days during the Rio 2016 Summer Paralympic Games. Illness data were obtained daily from teams with their own medical support through the WEB-IISS electronic data capturing systems.

RESULTS:

The total number of illnesses was 511, with an illness incidence rate (IR) of 10.0 per 1000 athlete days (12.4%). The highest IRs were reported for wheelchair fencing (14.9), para swimming (12.6) and wheelchair basketball (12.5) (p<0.05). Female athletes and older athletes (35-75 years) were also at higher risk of illness (both p<0.01). Illnesses in the respiratory, skin and subcutaneous and digestive systems were the most common (IRs of 3.3, 1.8 and 1.3, respectively).

CONCLUSION:

(1) The rate of illness was lower than that reported for the London 2012 Summer Paralympic Games; (2) the sports with the highest risk were wheelchair fencing, para swimming and wheelchair basketball; (3) female and older athletes (35-75 years) were at increased risk of illness; and (4) the respiratory system, skin and subcutaneous system and digestive system were most affected by illness. These results allow for comparison at future Games.

Objective: To evaluate the test-retest reliability of the Life Satisfaction Questionnaire (LiSat-11) and the association between items in individuals with chronic stroke. Design: Test-retest design. Subjects: Forty-five individuals (mean age 65 years) with mild to moderate disability at least 6 months post-stroke. Methods: LiSat-11, which includes 1 global item "Life as a whole" and 10 domain-specific items, was rated on 2 occasions, one week apart. Test-retest reliability was evaluated by kappa statistics, the percent agreement (PA) and the Svensson rank-invariant method. The association between items was evaluated with the Spearman's rank correlation coefficient (rho). Results: The kappa coefficients showed good to excellent agreement (0.59-0.97) and the PA <= 1 point was high (> 89%) for all items. According to the Svensson method, a small systematic disagreement was found for "Partner relationship". The other items showed no systematic or random disagreements. All domain-specific items, except one ("Sexual life") were significantly correlated with "Life as a whole" (rhos 0.29-0.80). Conclusion: LiSat-11 is considered reliable and can be recommended for assessing life satisfaction after stroke. The association between items indicates that LiSat-11 measures various aspects that can impact on an individual's life satisfaction.

OBJECTIVES:

To assess the presence of depressive symptoms among older adults with long-term spinal cord injury and investigate the association with sociodemographic and injury characteristics; and to determine how potentially modifiable factors, i.e. secondary health conditions, sense of coherence, coping strategies and leisure-time physical activity, are associated with depressive symptoms.

DESIGN:

Cross-sectional study.

SUBJECTS:

A total of 122 individuals (70% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D), mean age 63 years, mean time since injury 24 years.

METHODS:

Data from the Swedish Aging with Spinal Cord Injury Study, collected using the Geriatric Depression Scale-15, the 13-item Sense of Coherence Scale, the Spinal Cord Lesion-related Coping Strategies Questionnaire and the Physical Activity Recall Assessment for people with Spinal Cord Injury. Associations were analysed using multivariable linear regression.

RESULTS:

A total of 29% reported clinically relevant depressive symptoms and 5% reported probable depression. Sense of coherence, the coping strategy Acceptance, neuropathic pain and leisure-time physical activity explained 53% of the variance in depressive symptoms.

CONCLUSION:

Older adults with long-term spinal cord injury report a low presence of probable depression. Mental health may be supported through rehabilitation that strengthens the ability to understand and confront life stressors, promotes acceptance of the injury, provides pain management and encourages participation in leisure-time physical activity.

BackgroundFalls and fear of falling (FOF) are common in persons with late effects of polio but there is limited knowledge of associated factors.ObjectiveTo determine how knee muscle strength, dynamic balance and gait performance (adjusted for gender, age and BMI) are associated with falls and FOF in persons with late effects of polio.DesignA cross-sectional study.SettingA university hospital outpatient clinic.ParticipantsEighty-one ambulatory persons with verified late effects of polio (43 men; mean age 67 years).Main Outcome MeasurementsNumber of falls the past year, Falls Efficacy Scale –International (FES-I) to assess FOF, a Biodex dynamometer to measure knee muscle strength, the Timed Up and Go (TUG) test to assess dynamic balance and the Six Minute Walk test (6MWT) to assess gait performance. Univariate and multivariate logistic regression analyses were used for falls (categorical data) and linear regression analyses for FOF (continuous data) as dependent variables.ResultsFifty-nine % reported at least one fall during the past year and 79% experienced FOF. Reduced knee muscle strength in the more affected limb and gait performance were determinants of falls. An increase of 10 Nm in knee flexor and knee extensor strength reduced the OR between 0.70 and 0.83 (P=.01), and an increase of 100 meter in 6MWT reduced the OR to 0.41 (P=.001). All factors were determinants of FOF; reduced knee muscle strength in the more and less affected limbs explained 17% to 25% of the variance in FOF, dynamic balance 30% and gait performance 41%. Gender, age and BMI only marginally influenced the results.ConclusionsReduced gait performance, knee muscle strength and dynamic balance are to a varying degree determinants of falls and FOF in ambulatory persons with late effects of polio. Future studies need to evaluate if rehabilitation programs targeting these factors can reduce falls and FOF in this population. 

OBJECTIVE:

To explore how persons with late effects of polio experience falls and what strategies they use to manage the consequences of falls.

DESIGN:

A qualitative study with face-to-face interviews. Data were analysed by systematic text condensation.

PARTICIPANTS:

Fourteen ambulatory persons (7 women; mean age 70 years) with late effects of polio.

RESULTS:

Analysis resulted in one main theme, "Everyday life is a challenge to avoid the consequences of falls", and 3 categories with 7 subcategories. Participants perceived that falls were unpredictable and could occur anywhere. Even slightly uneven surfaces could cause a fall, and increased impairments following late effects of polio led to reduced movement control and an inability to adjust balance quickly. Physical injuries were described after the falls, as well as emotional and psychological reactions, such as embarrassment, frustration and fear of falling. Assistive devices, careful planning and strategic thinking were strategies to prevent falls, together with adaptation and social comparisons to mitigate the emotional reactions.

CONCLUSION:

Experiences of falls greatly affect persons with late effects of polio in daily life. To reduce falls and fall-related consequences both problem-focused and emotion-focused strategies are used. In order to increase daily functioning, these findings should be included in a multifaceted falls management programme.

STUDY DESIGN:

Cross-sectional.

OBJECTIVES:

To describe participation in leisure time physical activity (LTPA) (amount, intensity and type) among older adults with long-term spinal cord injury (SCI), and to investigate the associations with sociodemographics, injury characteristics and secondary health conditions (SHCs).

SETTING:

Home settings in southern Sweden.

METHODS:

Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS). The physical activity recall assessment for people with SCI was used to assess LTPA among 84 men and 35 women (mean age 63.5 years, mean time since injury 24 years, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D). Associations were analyzed statistically using hierarchical multivariable regression.

RESULTS:

Twenty-nine percent reported no LTPA, whereas 53% performed moderate-to-heavy intensity LTPA. The mean minutes per day of total LTPA was 34.7 (±41.5, median 15, range 0-171.7) and of moderate-to-heavy LTPA 22.5 (±35.1, median 5.0, range 0-140.0). The most frequently performed activities were walking and wheeling. Sociodemographics, injury characteristics and SHCs (bowel-related and bladder-related problems, spasticity and pain) explained 10.6% and 13.4%, respectively, of the variance in total and moderate-to-heavy LTPA. Age and wheelchair use were significantly, negatively associated with total LTPA. Women, wheelchair users and employed participants performed significantly less moderate-to-heavy LTPA than men, those using walking devices/no mobility device and unemployed participants.

CONCLUSION:

Many older adults with long-term SCI do not reach the amount or intensity of LTPA needed to achieve fitness benefits. Research is needed on how to increase LTPA and to identify modifiable factors that could enhance their participation.Spinal Cord advance

BACKGROUND:

New or increased impairments may develop several decades after an acute poliomyelitis infection. These new symptoms, commonly referred to as late effects of polio (LEoP), are characterised by muscular weakness and fatigue, generalised fatigue, pain at rest or during activities and cold intolerance. Growing older with LEoP may lead to increased activity limitations and participation restrictions, but there is limited knowledge of how these persons perceive the practical and psychological consequences of ageing with LEoP and what strategies they use in daily life. The aim of this qualitative study was therefore to explore how ageing people with LEoP perceive the their situation and what strategies they use for managing daily life.

METHODS:

Seven women and seven men (mean age 70 years) were interviewed. They all had a confirmed history of acute poliomyelitis and new impairments after a stable period of at least 15 years. Data were transcribed verbatim and analysed using systematic text condensation.

RESULTS:

The latent analysis resulted in three categories 'Various consequences of ageing with LEoP', 'Limitations in everyday activities and participation restrictions', and 'Strategies for managing daily life when ageing with LEoP' and 12 subcategories. The new impairments led to decreased physical and mental health. The participants perceived difficulties in performing everyday activities such as managing work, doing chores, partaking in recreational activities and participating in social events, thereby experiencing emotional and psychological distress. They managed to find strategies that mitigated their worries and upheld their self-confidence, for example finding practical solutions, making social comparisons, minimising, and avoidance.

CONCLUSION:

Ageing with LEoP affected daily life to a great extent. The participants experienced considerable impact of the new and increased impairments on their life situation. Consequently, their ability to participate in various social activities also became restricted. Social comparisons and practical solutions are strategies that facilitate adaptation and acceptance of the new situation due to LEoP. This emphasises the need to design rehabilitation interventions that focus on coping, empowerment and self-management for people ageing with LEoP.

BACKGROUND:

Reduced gait performance is common in persons with late effects of polio.

OBJECTIVE:

To identify predictors of change in gait performance over four years in persons with late effects of polio.

METHODS:

Gait performance was assessed annually in 51 ambulatory persons (mean age 64 years, SD 6) by the Timed “Up & Go” (TUG), Comfortable and Fast Gait Speed (CGS, FGS), and 6-Minute Walk Test (6MWT). Isokinetic knee extensor and flexor muscle strength was measured with a Biodex dynamometer. Mixed Linear Models were used to analyze changes in gait performance and to identify any predictors of change among the covariates gender, age, body mass index, time with new symptoms, baseline reduction in gait performance and knee muscle strength.

RESULTS:

There were significant linear effects over time (reduction per year) for three gait performance tests; CGS (0.8%; p < 0.05), FGS (1.7%; p < 0.001), and 6MWT (0.7%; p < 0.05) with significant random effects for all tests. The strongest predictor of a change in gait performance was the individual variations in the knee flexor strength (p < 0.001).

CONCLUSION:

The small gradual reduction in gait performance over time in persons with late effects of polio is primarily determined by the individual variations in the knee flexor strength.