Incorporating peers in exercise programs for people with spinal cord injury: Focus group findings

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Incorporating peers in exercise programs for
people with spinal cord injury Focus group
findings

• Mel Neri, BA
• Thilo Kroll, PhD
• Suzanne Groah, MD, MSPH
• Brenda Gilmore, BFA

APHA Annual Meeting December 12, 2005
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• NIDRR-funded Rehabilitation Research and Training
  Center (RRTC) on Spinal Cord Injury (SCI)
• Grant H133B031114
• Five year grant (12/03 11/08)

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RRTC on SCI Promoting Health Preventing
Complications through Exercise

• 5 Research Projects
• 4 Training Projects
• Prevention of selected secondary conditions
  through exercise physical activity

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National Rehabilitation Hospital (NRH)

• Research Division
• Neuroscience Research Center
• Center for Health Disability Research

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Collaborators

• Independent Living Research Utilization (ILRU)
• Miami Project to Cure Paralysis
• National Spinal Cord Injury Association (NSCIA)
• Spinal Cord Injury Network
• University of Dundee, School of Nursing
  Midwifery

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RRTC Research Project 4Comparison of Exercise
Training Formats in Individuals with Spinal Cord
Injury
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Background

• Peer mentoring can help to reduce the rate of
  secondary conditions in people with SCI
• Sable J, Craig P, Lee D. Promoting health and
  wellness A research-based case report. Ther
  Recreation J 2000 34 348-361.

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• Aerobic resistance training can reduce selected
  secondary conditions, e.g., pain depression in
  people with SCI
• Hicks AL, Martin KA, Ditor DS, Latimer AE, Craven
  C, Bugaresti J, McCartney N. Long-term exercise
  training in persons with spinal cord injury
  effects on strength, arm ergometry performance
  and psychological well-being. Spinal Cord 2003
  41 34-43.

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Can selected secondary conditions and unplanned
rehospitalizations be reduced by participation in
an exercise program with SCI peer mentors?
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Phase I

• Objective Determine role of peers in
  consumer-defined formats for home and community
  based exercise
• Design Qualitative - exploratory
• Method Focus groups

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Phase II

• Objective Determine the baseline rate of
  selected secondary conditions (e.g., pressure
  sores, pain, depression) and unplanned
  re-hospitalizations
• Design Prospective baseline study
• Method Standardized scales, Medical
  Complications Tracking Form

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Phase III

• Objective Determine if participation in a home
  or community based exercise program with a peer
  contributes to fewer secondary conditions and
  unplanned re-hospitalizations
• Design RCT with exercise intervention
• Method Standardized scales, Medical
  Complications Tracking Form, Exercise Logs

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Data and Methods Phase I

• Four focus group discussions held in fall 2004 in
  Washington, DC area
• Participants recruited from NRH, CILs, Inova
  Hospital SCI Support Group, NSCIA Resource
  Center, SCI Network
• Discussions were 90 minutes long, audiotaped,
  and transcribed

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Focus Group Characteristics (n20)

• Race
• 11 Caucasian
• 6 African-American
• 2 Hispanic
• 1 Asian
• Marital status
• 10 married
• 6 single 4 divorced

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• Age (Mdn)
• 43 years
• min 20 years max 67 years
• Sex
• 16 male
• Injury level
• C (7) T (8) L (5)
• Years post-injury (Mdn)
• 14 years
• min 1 year max 41 years

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Analysis

• Transcripts coded independently in NVivo by 2
  researchers
• 69 initial codes (themes) emerged
• Further refinement of coding structure was agreed
  upon by the researchers
• 60 final codes emerged

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Focus Group Findings
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Exercise Facilitators Barriers

• Facilitators
• Personal motivation
• Independence
• Accessible environment equipment

• Barriers
• Laziness
• Unsafe inaccessible equipment
• Boring routines

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Appropriate and Effective Exercise Formats

• Knowledgeable people involved in exercise
  programs
• Educational period before exercise begins
• Convenient location and time
• Adjustable and accessible equipment

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The role of peers in an exercise program for
adults with SCI

• Peers as
• Educators
• Resources
• Motivators

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• Help with safety and new activities (educator)
• one thing that would be important for any
  program that you start is for all new members to
  go through an initial education period.

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• Not necessarily an exercise buddy, but a
  resource person and problem-solver

• show how they have made accommodations to
  movements
• Thats where your peer comes in because if
  youve got somebody whos already figured it
  outits all about problem solving.

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• Motivator after exercising has begun
• I need somebody in the room that can nudge
  mesomebody thats going to pat me on the back
  when I do it exercise.

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Implementation of the Peer Component in an
Exercise Program
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• Peers as Educators
• Peers are trained via the SCI Network Peer Mentor
  Training Program
• Peers will co-teach the Benefits of Exercise
  lecture with physical therapist
• Peers will be involved in defining individualized
  exercise programs with participants and physical
  therapist

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• Peers as Resources
• Peers will suggest exercises when necessary
  (e.g., videos, outdoor recreation)
• Peers can introduce their own recreational
  pursuits (e.g., golfing, tennis) to others with
  SCI
• Peers were physically active before their injuries

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• Peers as Motivators
• Peers were specifically asked about their current
  exercise habits during job interview
• Peers were also asked about motivational skills
  during job interview
• Peers will be trained in goal-setting techniques

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Additional Peer Responsibilities

• Data collection 2x/month
• Regular phone/in-person contact with participants
• Review exercise videos/DVDs used for home
  programs
• Help transition intervention participants into
  exercise program

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Next Steps Phase II

• Determine the baseline rate of selected secondary
  conditions and unplanned re-hospitalizations
• Recruit 80 adults with SCI in DC area
• Administer selected standardized scales, Medical
  Complications Tracking Form

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Next Steps Phase III

• RCT, implementing exercise programs with SCI peer
  mentors
• Intervention participants can self-randomize into
  
• Six months of home-based exercise with a peer
• Six months of community-based exercise with a peer

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• www.sci-health.org