Lifestyle and health changes in wheelchair users with a chronic disability after 12 weeks of using the WHEELS mHealth application

Figures & data

Figure 1. Schematic overview of the study protocol.

Body composition measurements and questionnaires were administered in the week prior to and the week after the 12-week intervention. Nutrition diaries were collected during the first week and in the week after the 12-week intervention. Fitbit data were continuously collected from 1 week prior until the end of the 12-week intervention period.

Figure 2. Flow chart of participant’s inclusion.

45 individuals showed interest in participating in the study, of which one withdrawn and 11 were excluded based on inclusion- and exclusion criteria. Of the 33 individuals included in the study, three dropped out, resulting in 30 individuals finishing the 12-week intervention period.

Table 1. Demographic characteristics of the participants.

Characteristics	n	Frequency/Mean (SD)
Sex (female/male)	30	19/11
Age (y)	30	52.4 (11.1)
Height (m)	29	1.75 (0.10)
Body mass (kg)	20	79.9 (19.7)
BMI (kg/m^2)	20	25.8 (5.1)
Educational level	30
Lower educational level		1
Middle educational level		10
Higher educational level		19
Characteristics chronic disability	30
Spinal cord injury		20
Tetraplegia		6
Paraplegia		14
Unilateral lower-limb amputation		3
Cerebral palsy		1
Ehlers–Danlos syndrome		2
ADAM syndrome		1
Autoimmune cerebellar ataxias		1
Severe ankle trauma		1
Osteoarthritis of the spine		1

BMI, body mass index; ADAM, amniotic deformity adhesion mutilation.

Table 2. Experienced stage of change on nutrition and physical activity pre and post intervention (n = 28).

State of change regarding physical activity
Stage of change pre-intervention		Stage of change post-intervention
Stage of change	n	Stage of change	n
Precontemplation	1	Precontemplation	1
Contemplation	7	Contemplation	4
Preparation	14	Preparation	2
Action	0	Action	15
Maintenance	6	Maintenance	6
State of change regarding nutrition
Stage of change pre intervention		Stage of change post intervention
Stage of change	n	Stage of change	n
Precontemplation	0	Precontemplation	2
Contemplation	1	Contemplation	1
Preparation	6	Preparation	0
Action	1	Action	7
Maintenance	20	Maintenance	18

Table 3. Regression analyses on Fitbit data.

Random intercept mixed model	√steps
	n	β	Std. error	P value
Control week	26	77.6	11.5
Start period intervention	29	0.6	1.5	1.00
Middle period intervention	28	3.8	1.5	.042
End period intervention	29	1.5	1.5	.97
Random intercept panel linear model	Sleep minutes				Sleep efficiency (%)
	n	β	Std. error	P value	β	Std. error	P value
Control week	25	427.1	83.4		93.8	1.3
Start period intervention	29	–7.7	6.0	.20	–1.0	0.7	.14
Middle period intervention	27	–13.0	6.1	.035	–1.5	0.7	.032
End period intervention	27	–9.7	6.1	.12	–1.2	0.7	.10

Control week was used as reference.

n = amount of period averages available for analysis of each period.

β = average variable outcome (control week) and average difference compared to control week.

Std. error = standard error.

Significant p values are marked in bold.

Table 4. Nutritional intake pre and post 12-week intervention based on diet records (n = 26).

Daily average consumed	Pre Mean (SD)	Post Mean (SD)	P value	Effect size d
Energy (kJ)	6789 (1743)	5767 (1364)	.001	.71
Protein (g)	70.2 (18.4)	61.9 (17.4)	.005	.61
Fat (g)	67.5 (18.0)	54.4 (17.7)	<.001	.87
Carbohydrates (g)	183.6 (70.9)	160.2 (51.1)	.071	.37
Protein (%)	17.6 (3.7)	18.1 (3.9)	.42	.16
Fat (%)	37.9 (8.5)	35.5 (8.2)	.11^a	.32^a
Carbohydrates (%)	44.5 (8.9)	46.4 (8.9)	.26	.23

^aIndicates non-parametric test used with corresponding effect size due to violation of normality.

Significant p values are marked in bold.

Table 5. Body composition changes pre and post 12-week intervention (n = 27).

Body composition	n	Pre Mean (SD)	Post Mean (SD)	P value	Effect size d
Body mass (kg)	19	80.9 (19.7)	78.7 (18.4)	.015	.61^a
BMI (kg/m^2)	19	26.2 (4.9)	25.4 (4.4)	.007	.68^a
Waist circumference (cm)	27	99.3 (15.1)	96.0 (13.8)	<.001	.80

BMI, body mass index.

^aHedges’ g effect size.

Significant p values are marked in bold.

Table 6. Results from questionnaires pre and post 12-week intervention (n = 28).

Questionnaire	Pre Mean (SD)	Post Mean (SD)	P value	Effect size d
PASIPD (MET h/day)	11.1 (10.3)	18.9 (12.4)	.001^a	.65
Body satisfaction	–.61 (1.12)	0.58 (1.21)	<.001^a	.80
Body function	–.53 (1.31)	0.69 (1.40)	<.001^a	.76
Body appearance	–.80 (1.46)	0.30 (1.75)	<.001^a	.67
ESES	33.2 (4.5)	34.8 (4.0)	.092^a	.32
CIS20R	74.2 (25.1)	59.1 (24.9)	<.001	.79
PSQI	7.1 (3.3)	6.7 (2.3)	.71	.07
SF-36^E
Physical functioning	41.8 (24.0)	49.8 (26.8)	.059	.37
Social functioning	71.4 (22.8)	73.2 (19.2)	.66^a	.08
Role limitation physical	47.1 (23.8)	57.1 (22.4)	.012	.51
Role limitation emotional	78.9 (23.3)	81.3 (21.0)	.81^a	.04
Mental health	72.5 (17.5)	79.8 (13.0)	.002^a	.58
Vitality	54.7 (19.0)	63.8 (18.7)	.002	.64
Pain	39.4 (10.2)	62.1 (20.5)	.077	.35
General health perceptions	53.0 (20.7)	57.3 (20.2)	.11	.31

^aIndicates non-parametrical test used with corresponding effect size due to violation of normality.

Significant p values are marked in bold.

PASIPD, Physical Activity Scale for individuals with Physical Disability, ESES, Exercise Self-Efficacy Score, CIS20R, Checklist Individual Strength, PSQI, Pittsburgh Sleep Quality Index; SF36^E, Short-Form Health Survey 36 Enabled.