Atividades físicas adaptadas na promoção de independência funcional e qualidade de vida em indivíduos com lesão na medula espinhal

Abstract

Spinal cord injury (SCI) has physical, psychological and social repercussions for the affected individuals, their families and society. Adapted physical activity (APA) is a tool for developing motor skills and physical, emotional and social capacities, helping to achieve success in rehabilitation. However, there is no consensus on the effects of different types of practice on health and performance of this population, considering their sociodemographic characteristics, and little is known about the factors that interfere with adherence to practice after rehabilitation program. The general aim of this study is to investigate the association between the practice of APA and levels of quality of life (QoL) and functional independence (FI) among individuals with SCI who have been followed up in an internal rehabilitation program over a 20-year period. Specific aims are to compare levels of QoL and FI among individuals who practice para-sports, non-sports physical exercise and those who are sedentary, also evaluating the level of association of the sample's sociodemographic characteristics with these results and identifying factors associated with adherence to practice in the community. To characterize the sample and form "para-sport" (PD), "physical exercise" (PE) and "sedentary" (SE) groups, a semi-structured interview was conducted with 107 patients admitted between 2000 and 2020, who reported continuing to practice sports in the community after rehabilitation, and 37 who maintained a sedentary lifestyle. Reports were collected on barriers and facilitators to practicing in the community and questionnaires were used to assess QoL (WHOQOL-Dis-D) and FI (BrSCIM-SR). For the statistical analysis, the Kruskall- Walis test was applied to compare the scores of the scales between groups and a multiple linear regression model was adjusted to check the level of association with sociodemographic characteristics. The barriers most reported by the sample were "lack of places to practice" (26.4%), "lack of accessibility" (22.9%) and "motivation" (16.7%), while the facilitators were "rehabilitation guidance" (24.3%), "motivation" (22.2%) and "support network" (18.1%). In the QoL analysis, except for the "national" score, the PD group was superior to the SE group in all the WHOQOL-Dis-D domains and the PE group was not superior in the "social relationships", "factors" and "national" domains; there was no difference in the PD x PE comparison (p<0.017). Female participants had lower mean scores in "physical" domain [- 10.19(±4.52)] and in "general" score [-12.96(±5.38)] and aging indicated a reduction in the "general DISQOL" score [-0.156(±0.072)]. In the FI analysis, the PD group was superior to the SE group in all BrSCIM-SR scores, the PE group only in "mobility" and "total" and there was no difference between PD and EF (p<0.017). Participants with tetraplegia had lower scores than those with paraplegia. It was concluded that the practice of APA is associated with better levels of QoL and FI in the study sample, and that the practice of para-sports seems to be more effective in promoting social inclusion, autonomy and independence in self-care. It is suggested that these practices be promoted in rehabilitation programs and by public authorities, contributing to building a society that overcomes discrimination and prioritizes inclusion.