ourse of Gross Mechanical Efficiency in Handrim Wheelchair ropulsion During Rehabilitation of People With Spinal Cord njury: A Prospective Cohort Study

Objective: To investigate the course of mechanical effiiency of handrim wheelchair propulsion during rehabilitation f subjects with (in)complete paraplegia and tetraplegia. Design: Subjects were tested at the start of active rehabiliation (t1), 3 months later (t2), and when discharged from npatient rehabilitation (t3). They performed two 3-minute subaximal treadmill exercise blocks in a wheelchair. Setting: Eight rehabilitation centers in the Netherlands. Participants: Ninety-two people with (in)complete parapleia and tetraplegia. Interventions: Not applicable. Main Outcome Measures: Mechanical efficiency values ere calculated for each block. The course of mechanical fficiency was investigated using test occasions (t1–t3), comleteness and level (paraplegia or tetraplegia) of the lesion, and ower output as independent variables in a multilevel regresion analysis. Results: Mechanical efficiency significantly increased beween t1 and t2 only. After adding level and completeness of the esion and their interactions with time to the model, block 2 howed that subjects with paraplegia had a significantly higher echanical efficiency than subjects with tetraplegia. Subjects ith tetraplegia improved more between t1 and t2. Differences n mechanical efficiency between subjects with paraplegia and etraplegia could not be explained by differences in absolute nd relative power output levels. Conclusions: Results showed a significant improvement in echanical efficiency during the first 3 months of active rehailitation. Subjects with paraplegia showed a higher mechani-