Expert consensus for a digital peer-led approach to improving physical activity among individuals with spinal cord injury who use manual wheelchairs.

CONTEXT: Active Living Lifestyles for manual wheelchair users (ALLWheel) uses a digital peer-led approach to incorporate two behavior change theories to address a critical need for leisure-time physical activity (LTPA) programs for individuals with spinal cord injury (iSCI). OBJECTIVE: The objective of this study was to obtain expert opinion and consensus for the ALLWheel program. DESIGN: Mixed-methods (qualitative and quantitative) were used to gather expert opinion and consensus for the ALLWheel program using an action research approach. SETTING: Rehabilitation center. PARTICIPANTS: Experts in SCI and LTPA included iSCI who used manual wheelchairs, healthcare professionals, and community collaborators. PROCEDURES: Two, 90-minute focus groups were conducted and transcribed verbatim, analyzed thematically, and the results were used to create a Delphi survey. Delphi surveys were completed online using consecutive rounds until ≥70% consensus per item was attained. Cumulative percent concordances were calculated to determine consensus. RESULTS: Twelve experts in SCI and LTPA participated in focus groups. Four themes were generated: Need for LTPA programs; Important considerations; Perceptions about peer-coaches; and Feelings about smartphones, which were used to generate the Delphi survey. Consensus on the ALLWheel program was attained in two rounds. CONCLUSIONS: Experts established a need for fun and personalized community-based LTPA programs. Ensuring that healthcare professionals would be involved in the ALLWheel program alleviated safety concerns, and experts agreed there were benefits of peers delivering the program. Experts agreed that the ALLWheel program targeted important psychological factors (i.e. autonomy, relatedness, self-efficacy, and motivation) and affirmed the potential for a potentially large geographic reach.

Use of actigraphy to measure real-world physical activities in manual wheelchair users.

INTRODUCTION: The benefits of physical activity for manual wheelchair users are well-known. The purpose of this study was to validate actigraphy to objectively measure physical activity intensity among manual wheelchair users. METHOD: An experimental design was used. Adult manual wheelchair users wore a GT3X actigraph on their non-dominant arm while completing eight physical activities of low (reading), moderate (propelling -- flat) and high (propelling -- steep ramp) intensity. Heart rate and rating of perceived exertion were collected at the end of each physical activity. Distribution of data were examined and used to determine the type of repeated measures (parametric vs. non-parametric). A categorical principal component analysis was performed to determine the amount of variability explained by actigraphy, heart rate and rating of perceived exertion. Activity count cut-points were estimated using bootstrapping methods. RESULTS: Twenty-eight manual wheelchair users completed the study. Actigraphy, heart rate and rating of perceived exertion co-varied as physical activity intensity changed. Activity counts for low-intensity and medium-intensity physical activities were estimated to be 0 to 45 and 45 to 100 activity counts per second, respectively. Activity counts' ranges for high-intensity physical activities were not clear. CONCLUSION: Combining actigraphy and rating of perceived exertion could be an easy and reliable method to measure the intensity of real-world activities. Further research is needed confirm cut-points for physical activity intensity.