Physical capacity in wheelchair-dependent persons with a spinal cord injury: A critical review of the literature

Study design: Review of publications. Objective: To assess the level of physical capacity (peak oxygen uptake, peak power output, muscle strength of the upper extremity and respiratory function) in wheelchair-dependent persons with a spinal cord injury (SCI). Setting: Erasmus MC, University Medical Centre Rotterdam, The Netherlands. Methods: Pubmed (Medline) search of publications from 1980 onwards. Studies were systematically assessed. Weighted means were calculated for baseline values. Results: In tetraplegia, the weighted mean for peak oxygen uptake was 0.891/min for the wheelchair exercise test (WCE) and 0.871/min for arm-cranking or hand-cycling (ACE). The peak power output was 26W (WCE) and 40W (ACE). In paraplegia, the peak oxygen uptake was 2.101/min (WCE) and 1.51l/min (ACE), whereas the peak power output was 74W (ACE) and 85W (WCE). In paraplegia, muscle strength of the upper extremity and respiratory function were comparable to that in the able-bodied population. In tetraplegia muscle strength varied greatly, and respiratory function was reduced to 55-59% of the predicted values for an age-, gender- and height-matched able-bodied population. Conclusions: Physical capacity is reduced and varies in SCI. The variation between results is caused by population and methodological differences. Standardized measurement of physical capacity is needed to further develop comparative values for clinical practice and rehabilitation research. Sponsorship: Supported by the Health Research and Development Council of The Netherlands (grant nos. 1435.0003; 1435.0025). © 2006 International Spinal Cord Society. All rights reserved

Standardizing endpoints in perioperative research

Measuring patient-relevant, clinically important, and valid outcomes is fundamental to the delivery of high-quality clinical care and to the innovation and development of such care through research. As surgical innovations become more complex and the burden of age and comorbidities in the surgical patient population continues to increase, understanding the benefits and harms of surgical interventions becomes ever more important. Nevertheless, we can understand only what we can adequately describe. Truly collaborative decision-making, delivery of safe effective care, and on-going quality improvement are also critically dependent on reliable valid measurement of patient-relevant and clinically important data. Attempts to describe the full spectrum of outcomes following surgery necessarily entail moving beyond the traditional endpoints of mortality and resource use towards more complex measures of morbidity, patient-reported outcomes, and functional status. Without standardization and consensus to guide the use of increasingly complex and nuanced endpoints, there is a real risk that perioperative research will become embroiled in a mire of inconsistent heterogeneous outcome measures that cannot be meaningfully compared and contrasted between trials or combined within meta-analyses. This would result in limiting the value of the research effort and depriving patients and clinicians of definitive answers. Collaboration in perioperative medicine-whether between institutions or across continents-has enormous potential to improve the value of research output. Standardizing endpoints for outcome measurement is fundamental to maximizing the quality of such collaboration and ensuring the impact of future perioperative research