A nurse-coached exercise intervention to increase muscle strength, improve quality of life, and increase self-efficacy in people with tetraplegic spinal cord injuries: A single subject design study

A nurse-coached exercise intervention to increase muscle strength, improve quality of life, and increase self-efficacy in people with tetraplegic spinal cord injuries: A single subject design study Dissertation by Susan Budassi Sheehy, Ph.D., R.N. , F.A. E.N. , F.A. A.N. Chair: Mary E. Duffy, Ph.D., R.N. , F.A. A.N. A nurse-coached exercise intervention was conducted over a period of two years in a community based YMCA, using specialized equipment adapted for people with tetraplegic spinal cord injuries. Ten people with tetraplegic spinal cord injuries participated in the study, each completing three three-hour nurse-coached exercise sessions a week over a period of six months. The purpose of the study was to determine what effects a nurse-coached exercise intervention would have ob muscle strength, self-reported self-efficacy, and quality of life. Results of the Manual Muscle Test (MMT), Moorong Self-Efficacy Scale (MSES), and Catz-Itzkovich Spinal Cord Independence Measures (CI-SCIM), the dependent variables, were collected at baseline (twice), and at three months into the intervention and at six months, which was the conclusion of the intervention. The Sheehy Spinal Cord Injury Functional Improvement Via Exercise (SCIFIVE) Model was constructed prior to the study and validated throughout the course of the study. Components of the SCI-FIVE Model include the spinal cord injured person, the nurse-coach, the exercise intervention in a community environment, and the presence of others with spinal cord injuries participating in the study who would provide encouragement and opportunities for vicarious learning. The expectations of the model were that, as muscle strength increased, functional ability would improve, resulting in greater independence, a higher sense of self-efficacy, and a higher quality of life. Research question #1, “What effect does a nurse-coached exercise program for people with tetraplegic spinal cord injuries have on muscle strength? ” was determined by visual analysis of participants’ MMT graphs and statistical analysis of the combined data of the ten study participants. Muscle strength improved in each participant. Of those muscles that demonstrated some strength at baseline, 75% experienced increased muscle strength at three months and/or six months into the intervention. Of those muscles that demonstrated no strength at baseline that were adjacent to muscles that had some strength, 66% were found to have increased strength at three months and/or six months. These results were consistent across ten participants regardless of the length of time since injury and validated that component of the Sheehy SCI-FIVE Model. The answer to research question #2, “What effect does a nurse-coached program of exercise for people with tetraplegic SCI have on quality of life? ” was determined using visual analysis of results from the CI-SCIM and it’s three subscales. Nine of ten study participants experienced upward trends in CI-SCIM scores overall. To determine whether CI-SCIM changes observed in each participant were statistically significant over all ten participants, Repeated Measures Analysis of Variance (R-ANOVA) was conducted with CI-SCIM Overall and the subscales of Self Care, Respiratory and Sphincter Management, and Mobility. CISCIM overall results support the efficacy of the intervention and validate this tenet of the Sheehy SCI-FIVE Model ((F (3,27), =16.5, p<. 0001; Friedman’s = 2.67, p<. 0001). The subscale Self Care was statistically significant (F(3.27=20.1, p<.0001; Friedman’s = 26.7, p<.0001). The subscale Mobility results supports the efficacy of the intervention. R-ANOVA indicated significant changes over time (F(3,27), = 8.6, p<. 0001; Friedman’s = 23.3, p<. 0001). The subscale Respiratory and Sphincter Management results did not support the efficacy of the intervention. There were no statistically significant changes over time (p=.11). The MSES was used to assess changes in self-reported self-efficacy in response to RQ #3, “What effect does a nurse-coached program of exercise for people with tetraplegic SCI have on self-efficacy? " Visual analysis of graphs revealed that all ten study participants experienced strong improvements in MSES scores from baseline to three months and from three months to six months. R-ANOVA confirmed statistical significance across ten subjects (F(3,27) = 24.6, p<. 0001; Friedman’s = 30.0, p<. 0001) and validated this tenet of the Sheehy SCI-FIVE Model. The results of this study validated all components of the Sheehy SCI-FIVE Model and demonstrated increased muscle strength, increased self-efficacy, and improved quality of life for the ten study participants who participated in a nurse-coached program of exercise for people with tetraplegic SCI.