Increasing Muscle Strength, Self-Efficacy, and Quality of Life in People with Tetraplegic Spinal Cord Injuries: A Nurse-Coached Intervention

Tuesday, 23 July 2013: 3:30 PM

Susan B. Sheehy, PhD, RN, MSN, MS, FAEN, FAAN
Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD

Learning Objective 1: Identify elements of the Sheehy SCI - Functional Improvement via Exercise Model and discuss the significance/inter-relationship of each as they relate to health promotion

Learning Objective 2: Discuss how evidence-based practice can influence research and how research can influence evidence-based practice in catastrophic injury populations with chronic health issues

Purpose: The purpose of this study was to determine if a nurse-coached program of exercise for people with tertaplegtic spinal cord injuries would result in increased muscle strength, increased self-efficacy scores, and a higher quality of life

Methods: This was a single subject, multiple baseline, across subjects, A-B design. There were ten participants in the study (N=1, ten times) that took place over a two-year period of time. Exercises were designed specifically for people with tetraplegic injuries. Each participant was coached three times a week, in three-hour sessions, over six months. Baseline measurements were obtained for muscle strength (Manual Muscle Test), self-efficacy (Moorong Self-Efficacy Score), and quality of life (Catz-Itzkovich SCI Quality of Life Index) and repeated at three and six months. The Sheehy Spinal Cord Injury Functional Improvement Via Exercise (SCI-FIVE) Model was the guiding framework for the study. Visual graph slope analysis, using single subject methodology, was used to analyze data. 

Results: All participants experienced muscle strength increases. In the three quaiity of life sub-scales, nine experienced improvements in self-care, two experienced improvements in bowel/bladder management, and seven experienced improvements in mobility. All participants experienced increases in self-efficacy scores. All components of the Sheehy SCI-FIVE Model were validated. Anectdotally participants reported no medical illnesses (urinary and respiratory tract infections), no skin breakdown issues (pressure sores), better sleep, less spasticity, less pain (especially shoulder pain).  

Conclusion: Evidence now exists that a nurse-coaced program of exercise for people with tetraplegic spinal cord injuries may result in a higher quality of life as a result of increased muscle strength and improved self-efficacy. People with SCI can live healthy, active lives, regardless of the length of time that has elapsed since their original injuries.