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ProACTIVE Toolkit Guidelines Aid Physio Rehab and Peer Support

ProACTIVE Toolkit helps boost fitness during SCI rehab and beyond

Praxis is a Canadian-based not-for-profit organization that leads global collaboration in spinal cord injury research, innovation, and care. We accelerate the translation of discoveries and best practices into improved treatments for people with spinal cord injuries.

We measure our success through how we make a difference to the spinal cord injury (SCI) community.

“Well, I would have to talk about the mental health aspect [of it]…there have been times where it was really dark. The [mental health boost is the] most important benefit that I’m getting from this, even though the physical benefit is massive as well. So, it is kind of tough, but I think without the mental the physical wouldn’t be possible.”

ProACTIVE study participant with SCI

When individuals return to living in the community after a spinal cord injury (SCI), there is a significant reduction in physical activity. This lack of activity impacts an individual’s health and recovery. To address this, researchers and physiotherapists are combining peer coaching with exercise guidelines from the ProACTIVE toolkit to set motivational milestones for adults with SCI returning to the community. Participants and physiotherapists have found the results highly encouraging.

Why Physical Activity?

For many patients with an SCI in B.C., the recovery process starts with acute stage clinical management right after the injury. Once stabilized, care often moves into rehabilitation in the hospital, followed by a return to the community. The initial two phases are closely supervised but in the community many individuals are unsupported and can end up with reduced physical activity and poor health outcomes.

“I know somebody is there. There is always somebody there.”

ProACTIVE study participant with SCI

It can be difficult to motivate an individual towards physical fitness on top of the rehab exercises that they’re sent home with to restore function and promote healing. However, there are big benefits from being active in terms of physical and mental health. This helps people with SCI integrate better back into their communities.

“[The ProACTIVE Toolkit] gives us a starting point to bring up a physical activity plan relating to strength and fitness as opposed to a rehab plan. It also allows us to separate strength and fitness plan as part of return to normal wellness living, from full time rehab exercise.”

GF Strong Rehab Specialists

What is the ProACTIVE Toolkit?

The ProACTIVE toolkit was developed with support from Praxis with input from more than 300 members of the SCI community in B.C. to change the game on activity. Clinicians, people with SCI, and researchers from UBC and UBC Okanagan developed the toolkit to guide exercise done during rehabilitation and after returning to the community.

The toolkit focuses beyond rehab towards physical activity, promoting leisure time activity and wheeling or active transportation. Current guidelines state that people with SCI should aim for 20 minutes of moderate to vigorous intensity aerobic activity and three sets of eight to ten repetitions of strength training exercises for each major functioning muscle group twice a week for fitness. For cardiometabolic health, they should also aim for 30 minutes of moderate to vigorous intensity aerobic activity at least three times per week.

A recent study has looked at the impact peer coaching and support had on physical activity levels among those returning to the community, using the ProACTIVE toolkit as a framework and guide for exercise.

Physiotherapists and peer coaches from SCI BC have been trained on using the toolkit, with the peer coaches providing ongoing support in the community. Goal setting is used to help establish motivational milestones for aerobic and strength training in order to meet the physical activity guidelines for adults with SCI.

The response has been good, from both practitioner and patient groups. Physiotherapists report improved physical activity and fitness levels for their SCI clients, while the patients themselves report enhanced support, better mental wellbeing and increased fitness.

SCI Participant Feedback

“I would probably say that all these experiences I’ve had are for the positive. [SCI Peer] was always there for me and kept me on track.” 

“It’s been overall positive because, you know, I can tell that I am healthier and stronger than I was.” 

“They are not only help[ing] us exercise, but more important, they teach us about new ownership and a new area of my life that is important.” 

“My [SCI peer] would pick up on anything that I had a concern about and have an answer for it.” 

 “I think that that’s probably a positive, because you got a chance to sort of debrief and talk about what progress you’ve made and where you’re going in a supported way.”

“I mean the positives, were just, you know, a lot of reinforcement and a lot of reminders and a lot of, you know, just patience. And so, it yeah like I found it to be very helpful.” 

“But the positive is definitely the peer connection and being able to [say], oh I tried this and it wasn’t really working and, providing some guidance on it”

This positive impact was mirrored by feedback from the physiotherapists.

• There’s a physical activity plan in place that they can refer to when they are discharged from rehab, which can be used to guide progress when in the community.
  
• They know they will have support in place (SCI peer coaches) for when they need some problem-solving assistance etc. They don’t have to figure this out themselves. This will also help facilitate success, both in the short term and long term.
  
• Helps to maintain motivation when there is a peer coach to be accountable to.
  
• Clients have a contact in the community who have lived experience in achieving and maintaining physical activity goals.
  
• Connects clients with SCI BC, which they might not have done otherwise.

The practitioners summarized their experience with the toolkit allied to peer coaching in the community:

• Gives us ready resources to give the client, which are simple, easy to understand and easy to use with an easy structured framework.
  
• Good reminder and education tool for the therapists of the importance of progressing/maintaining physical activity in the SCI population. It is easy to forget once rehab stops.  
  
• Gives us a good handover point when we can transfer the exercise guidance to SCI peer coaches when they are discharged from us (in- and outpatient). Many patients are fearful and reluctant to leave us when their rehab program finishes. Handing over to the SCI peers is a much better flow and continuum for the overall trajectory of SCI health and wellness.  

“The ProACTIVE project has changed how we can provide support for our patients as they are discharged … Prior to this project, often therapists had no opportunity to provide a cardiovascular fitness program to patients, and the ProACTIVE toolkit has given us a standard way to start this conversation knowing there will be ongoing support.

This project allows patients to return to physical activity with the focus of incorporating it into their normal lives instead of being focused solely on their “rehab exercises”, which often are seen as temporary. For patients not yet ready to start a cardiovascular fitness routine when they are discharged from GF Strong, they can be followed up by SCI BC peers to support them when they are ready.”

Therapists at GF Strong