RESNA 27th International Annual Confence

Technology & Disability: Research, Design, Practice & Policy

June 18 to June 22, 2004
Orlando, Florida


Do Organized sporting events make a difference for individuals who use wheelchairs?

  Stephanie G Martin, BS, Shirley G Fitzgerald, PhD, Rory A Cooper, PhD, Diane M Collins, OTR/L, MA
University of Pittsburgh,
Dept. Rehabilitation Science and Technology
VA Pittsburgh Healthcare System

ABSTRACT

To determine if participants active in organized sports exhibited less depressive symptoms and higher levels of community participation than those who are not active in sport, a cross-sectional study was conducted. Depressive symptoms, as measured by the Center for Epidemiologic Studies--Depression, were examined along with community participation, which was assessed with the mobility, occupation, and social integration scores from the Craig Handicap Assessment Reporting Technique. No significant differences were found in the community participation variables, but participants active in organized sported exhibited significantly less depressive symptoms than participants not active in sports.

Keywords:

Community participation, depression, disability, organized sports, wheelchairs, wheelchair athletes

BACKGROUND

Published literature cites the multiple benefits derived from participating in active sports (1-3). Resistance to fatigue, enhanced cardiovascular fitness, improved social skills, and psychological health have all been found in studies involving individuals without disabilities. These same benefits are expected to be found for individuals who use wheelchairs and actively participate in sports.

Wheelchair sports provide a means for rehabilitation, travel, friendship, and other meaningful outcomes, and, therefore, are vital to many people with disabilities (4).

Previous studies comparing wheelchair athletes to non-athletes indicated that, although all scores for depressive symptoms have fallen within normal range, they were significantly lower, and therefore better, for athletes (5). Sport activities have also been identified as an outlet for frustration and anger, a source of self-esteem, as well as providing a sense of belonging to a team for those with mobility impairments (6). A pilot study was completed to determine depression levels and community participation in a group of athletes compared to individuals who do not attend organized sporting events.

RESEARCH QUESTION

Wheelchair users who participate in organized sports will exhibit lower depressive symptoms (as measured with the Center for Epidemiologic Studies Depression Scale) and greater community participation (as measured by the mobility, occupation, and social integration scores of the Craig Handicap Assessment Reporting Technique) than wheelchair users who do not participate in sports.

METHODS

This cross-sectional pilot study was conducted to examine certain lifestyle characteristics of athletes and non-athletes who use wheelchairs. For the purposes of this study, organized sports are defined as the National Veterans Wheelchair Games (NVWG), a multi-event sports and rehabilitation program for military service veterans who use wheelchairs for sports competition due to spinal cord injuries, amputations, or certain neurological problems (7). Twenty-seven subjects who participated in the NVWG completed questionnaires used to survey their lifestyle and behaviors. The participants were compared to another population of individuals who used wheelchairs but did not participate in the NVWG. Each participant of the NVWG was matched with a non-athlete on the basis of gender and disability or injury. This population was derived from an existing database; the members of this population completed similar questionnaires but did not compete in an organized sports setting. The questionnaire included the Center for Epidemiologic Studies Depression Scale (CES-D), which is a short, self-reported scale designed to measure a combination of depressive symptoms. Participants were asked to rate 20 statements to obtain a score from 0 to 60. Scores totaling 22 or more indicate some degree of depressive symptoms (8). Participants were also asked to complete the Craig Handicap Assessment Reporting Technique (CHART) to assess the outcome of interest--community participation. Although the CHART consists of several dimensions, for this study only the areas of social participation, mobility, and occupation were examined. For each dimension, a total continuous score was calculated; scores of 100 equate to no handicap in ability to perform the particular function being measured (9).

RESULTS

The two matched groups each consisted of 27 individuals: 22 male and 5 female. The majority had some level of spinal cord injury. The athletes were slightly older with fewer years since onset of disability or diagnosis than the non-athletes. To compare the community participation and depression scores of the two groups, paired t-tests were used when outcomes were normally distributed, and Wilcoxon Ranksom statistics were used with variables that were not normally distributed. Paired t-test results showed no significant differences in either CHART score of social integration or occupation in the two groups. Due to the data distribution, a non-parametric test was run; no significant difference was found in the other CHART score--mobility. However, the non-parametric test showed a difference with a significance of p=0.019 for depressive symptoms (Table 1).

Table 1 : Comparison of Demographics and Scores

Variables

Athletes

Non-Athletes

p-value

Age in years

51.6 (± 11.4)

48.2 (± 12.1)

.291

Years since diagnosis/injury

17.9 (± 10.4)

20.3 (± 18.1)

.234

Mobility scores

94.7 (± 11.3)

87.4 (± 19.2)

.083

Occupation scores

70.9 (± 30.8)

60.4 (± 33.7)

.325

Social integration scores

83.2 (± 24.0)

83.9 (± 17.4)

.930

CES-D scores

9.4 (± 10.2)*

16.8 (± 13.8)*

.019

*Significant at p<0.05

DISCUSSION

The difference between the levels of depressive symptoms of the two groups may indicate the importance and value of organized sports. However, the results may be limited due to the specificity of the organized sports as defined for this study. Also, we cannot prove causality: the NVWG participants may express less depressive symptoms because they participate, or do they participate because they are less depressed? Since our data on participants in the non-athlete group were from an existing database, their possible involvement in sports is unknown to us. If, considering these limitations, our findings are accurate; a valuable suggestion to veterans would be their participation in organized sporting events. Future plans include the inclusion of more females and progressive conditions in our research, as well as including a more general variety of organized sports.

REFERENCES

  1. Ahmadi J, Samavatt F, Sayyad M, Ghanizadeh A. (Jun 2002). Various types of exercise and scores on the Beck Depression Inventory. Psychological Report. 90 (3 Pt 1): 821-822.
  2. Paluska, SA, Schwenk TL. (Mar 2000). Physical activity and mental health: current concepts.
    Sports Medicine. 29(3):167-80. Review.
  3. Taylor CB, Sallis JF, Needle R. (Mar-Apr 1985). The relation of physical activity and exercise to mental health. Public Health Report. 100(2):195-202.
  4. Cooper RA, O'Connor TJ, Robertson RN, Langbein WE, Baldini, FD. (1999). An investigation of the exercise capacity of the wheelchair sports USA team. Assistive Technology . 11: 34-42.
  5. Paulsen P, French R, Sherrill C. (Dec 1990). Comparison of wheelchair athletes and nonathletes on selected mood states. Perceptual and Motor Skills. 71 (3 Pt. 2): 1160-1162.
  6. Cooper, RA. (1990 Summer). Wheelchair racing sports science: a review. Journal of Rehabilitation Research and Development, 27(3): 295-312.
  7. Website for National Veterans Wheelchair Games. http://www.appc1.va.gov/vetevent/nvwg/2004/
  8. Radloff L.S., The CES-D Scale: (1997). A new self-report depression scale for research in the general population. Applied Psychological Measurement. 3: 385-401.
  9. Tate D, Forchheimer M, Maynard F, & Dijkers M. (1994). Predicting depression and psychological distress in persons with spinal cord injury based on indicators of handicap. American Journal of Physical Medicine & Rehabilitation, 73(3): 175 - 183.

ACKNOWLEDGEMENTS

This was supported in part by the National Veteran's Wheelchair Games, WART/HERL, and VA Merit Review Grant D3078R, VA RR&D Pre-Doctoral AHRRFP. This was a VA Rehabilitation R&D Center Core supported project

Author:

Stephanie G Martin,
Human Engineering Research Laboratories,
VA Pittsburgh Healthcare System,
7180 Highland Dr., 151R-1
Pittsburgh, PA. 15206;
(412) 365-4945;
sgmst11@pitt.edu

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