Validity of heart rate indexes to assess wheeling efficiency in patients with spinal cord injuries.

Study Design: Cross-sectional study.

Objectives: To validate heart rate (HR) indexes for the evaluation of energy expenditure during wheelchair propulsion in people with spinal cord injury (SCI).

Setting: SARAH Rehabilitation Hospital Network-Brasilia, Brazil.

Methods: Forty-eight men aged 29.0±7.8 years with a SCI between C6 and L3 causing complete motor impairment were enrolled in the study. The assessment consisted of 5 min of rest while seated in the wheelchair, followed by 5 min of wheelchair propulsion at a self-selected comfortable speed. The main outcomes measured were oxygen consumption, HR, physiological cost index (PCI), total heart beat index (THBI) and propulsion cardiac cost index (PCCI).

Results: Using oxygen uptake as gold standard, the highest correlations were found between this and PCCI (r=0.59, P<0.001, 95% confidence interval (CI) 0.36-0.75) and THBI (r=0.58, P<0.001, 95% CI 0.36-74.0), independently of the injury level. The PCI had the lowest correlation coefficient (r=0.38, P<0.01, 95% CI 0.11-0.60). Spearman correlation analysis showed that the indexes mostly associated with lesion level were PCCI (ρ=-0.531; P<0.001; 95% CI -0.708 to -0.291) and THBI (ρ=-0.524; P<0.001; 95% CI -0.704 to -0.282).

Conclusions: Both THBI and PCCI seem to be valid measures for assessing energy expenditure. Both indexes showed a coherent correlation with the spinal injury level.