Physical fitness in people with a spinal cord injury: the association with complications and duration of rehabilitation.

OBJECTIVE To assess the association between physical fitness and its recovery over time on the one hand, and complications and duration of phases of rehabilitation on the other. DESIGN AND SETTING Prospective cohort study at eight rehabilitation centres. SUBJECTS People with a spinal cord injury were assessed four times: at the start of active rehabilitation (n = 110), three months later (n = 92), at discharge (n = 137) and a year after discharge from inpatient rehabilitation (n = 91). MAIN MEASURES Physical fitness was defined as aerobic capacity, determined at each occasion by the peak oxygen uptake (peak Vo(2); L/min) and the peak power output (peak PO; W) during a maximal exercise test. On these occasions, spasticity, musculoskeletal and neurogenic pain were determined (1 = present; 0 = absent). During inpatient rehabilitation, complications (urinary tract infection, pulmonary infection or pressure sore) and bed rest were registered (1 = complication; 0 = no complications, and 1 = bed rest; 0 = no bed rest). Complications and bed rest occurring during the year after discharge were registered similarly. RESULTS Multilevel random coefficient analyses revealed associations in multivariate models (P <or= 0.05). The peak oxygen uptake was negatively associated with complications after discharge. The recovery of peak power output over time was negatively associated with bed rest and spasticity. Both physical fitness and its recovery were negatively associated with the duration of active rehabilitation. CONCLUSION Results suggest that limiting complications, spasticity or bed rest may improve fitness. A longer duration of active rehabilitation is not associated with an increase in physical fitness.