(Research Hub Theater) The Perfect Step Is the First One: Improving Quality of Life for Patients with Spinal Cord Injuries Through Structured Exercise

Background and/or Objectives: More than 1 million people are living with spinal cord injuries (SCI) in United States alone. Despite research suggesting improvement in functional activities in patients who participate in regular physical activity, there is limited data on the specific impact of exercise as it pertains to patient reported quality-of-life (QoL) measures of general well-being, pain, independence, or medical complications.

Design: A pre-post evaluation of patient reported outcome measures after enrollment in a longitudinal structured exercise program.

Setting: Community-based fitness facility (The Perfect Step) in Claremont, California.

Participants: 24 patients with SCI (16 cervical, 4 thoracic, 3 lumbar, 1 unspecified).

Interventions: Patients were recurrent clients participating in a structured exercise program over two years which consisted at least two hours a week of exercise-based therapy, loadbearing, and neuroplasticity retraining.

Main Outcome Measures: Patient reported QoL outcomes were measured retrospectively at enrollment, 6 months, 12 months, and 24 months after enrollment in the program as measured by a 89-item SCI QoL questionnaire covering domains including: general wellbeing (39 items), pain (16 items), independence (7 items), bladder function (14 items), and pressure ulcers (13 items).

Results: Wilcoxon rank sum tests were used to compare patient-reported outcome measures of general wellbeing, pain, independence, and complications due to impaired bladder function and pressure ulcers over multiple timepoints. Patients reported statistically significantly improved outcomes across all domains at all timepoints to varying degrees, with improvement in 74/89 items at 6 months, 58/89 at 12 months, and 67/89 at 24 months post enrollment (p < 0.05, all).

Conclusions: Patients with SCI engaging in a structured exercise program demonstrated sustainable, longitudinal improvements in general well-being, pain control, and independence, and fewer impairments related to bladder function and pressure ulcers. Physiatrists should consider integration of structured exercise into the rehabilitation program alongside traditional medical care to optimize quality of life for those with spinal cord injuries.