Development and feasibility evaluation of a sedentary behaviour intervention in individuals with paraplegia

Abstract

Background: Individuals with spinal cord injury (SCI), such as paraplegia, are at a higher risk of cardiovascular disease (CVD) than non-disabled individuals. Furthermore, these individuals have high levels of sedentary behaviour, which is an independent risk factor for CVD. Reducing and breaking up sedentary behaviour could be a potential intervention focus for individuals with paraplegia. Currently, evidence around the effectiveness of sedentary behaviour interventions in individuals with paraplegia is unclear. Sedentary behaviour interventions have been shown to be effective in non-disabled individuals. However, due to the unique needs of manual wheelchair-users with paraplegia, it is unlikely that interventions designed for non-disabled individuals would be acceptable or effective for this population. Therefore, tailored sedentary behaviour interventions should be developed for individuals with paraplegia. Methods: A mixed-methods approach was used throughout this thesis. The initial ‘Development’ phase of the Medical Research Council (MRC) framework for developing and evaluating complex interventions was undertaken via a systematic review to explore the effects of interventions on sedentary behaviour and CVD biomarkers in individuals with paraplegia (Chapter 4), and development of a sedentary behaviour intervention using the Behaviour Change Wheel (Chapter 5). Subsequently, the ‘Feasibility’ phase of the MRC framework was undertaken via a feasibility study to evaluate the acceptability, safety, feasibility and preliminary efficacy of the intervention in individuals with paraplegia (Chapter 6). Results: The systematic review found that interventions specifically targeting sedentary behaviour show promise for improving this outcome and CVD biomarkers. The co-design study identified 29 barriers and facilitators to reducing and breaking up sedentary behaviour, which were then selectively targeted by specific intervention components: a wearable activity tracker, educational booklet, goal setting, motivational support, peer support and activity tools. Evaluation of this intervention found that it was acceptable, safe and feasible. In addition, the intervention showed preliminary efficacy for improving sedentary behaviour, physical activity, some CVD biomarkers and psychosocial health outcomes. Conclusion: This research contributes a novel co-designed, theory-driven sedentary behaviour intervention in individuals with paraplegia. The intervention was acceptable, safe and feasible to deliver, which can inform progression to a future definitive randomised controlled trial. If found to be effective, this research could inform future healthcare policy and public health guidelines in individuals with paraplegia, with a focus on reducing and breaking up sedentary behaviour to improve CVD biomarkers.