The use of patient-reported outcome measures during the day and in the evening to capture therapy dose dimensions in the active upper limb rehabilitation in subacute cervical spinal cord injury

Abstract

Introduction Rehabilitation improves arm-hand functioning in people with a cervical spinal cord injury (pwC-SCI); however, the optimal training dose is unknown. Therapists indicate the necessity of individualized therapy but lack the tools to capture the therapy dose. Patient-reported outcome measures after therapy sessions, as well as in the evening, might support therapists in evaluating individual therapy load. This study aims to (1) investigate the association between the perceived therapy dose during the therapy session and in the evening, as reported by the patient, and (2) investigate the association between the difficulty of the session and the general and physical fatigue, as reported by the patient. Methods A longitudinal observation study executed in three rehabilitation centers (in Belgium and the Netherlands) included pwC-SCI (i.e., lesions ranging from C1 to Th1 and AIS A-D and between 4-8 post-injury weeks at inclusion). Participants conducted a self-reported questionnaire before and after every active UL training session to rate the therapy dose dimensions, general fatigue, physical fatigue (as an indicator for the dose dimension' perceived intensity'), session difficulty (as the dose dimension perceived difficulty), and additional pain on a visual analogue scale from 0 to 10. A mean score of the different sessions during the day was calculated. Furthermore, an end-of-day questionnaire was administered in the evening, questioning the day's average general and physical fatigue and pain. These questionnaires were completed three days a week over three distinct weeks, with eight-week intervals during rehabilitation. Patient characteristics and dose dimensions were reported in means (M) and standard deviations (SD). Associations were calculated with Spearman's Rho. Results Data from 85 questionnaires during the day and 85 questionnaires in the evenings were analyzed involving 13 participants, all males (AIS B-D, C1-5, mean age 54.4 years (SD 12.9), mean time post-injury at inclusion 6.7 weeks (SD 1.8)). General and physical fatigue during the day (M=3.4; SD=1.3 and M=3.5; SD=1.4 respectively) shows a significant moderate (r=0.51; p<0.001 and r=0.65; p<0.001 respectively) correlation with these scores reported in the evening (M=4.7; SD=1.8 and M=4.1; SD=1.8). Pain during the day (M=2; SD=1) shows a significant but low correlation (r=0.44; p<0.001) with the pain scores reported in the evening (M=2.9; SD=1.4). Difficulty scores during the day (M=4.3; SD=1.6) show a significant low correlation with general (r=0.37; p<0.05) and physical fatigue (r=0.44; p<.001) in the evening. Difficulty scores during the day demonstrate a significant moderate correlation with general (r=0.58; p<.001) and physical (r=0.59; p<.001) fatigue during the day. Conclusion The moderate association between general and physical fatigue during the day and evening might indicate that end-of-day questionnaires can be used to estimate the dose dimension 'perceived intensity' in general. The perceived difficulty of a session is linked with the perceived general and physical fatigue during the day. As the correlation between pain after the session and in the evening is low, it is advised to ask about pain during the day.