Hypothesis 1: Program participation will improve health-related self-efficacy, increase subjects' nutritional awareness and health behavior, reduce stress, and improve physical fitness. These changes will, in turn, improve subjects' quality of life.

Hypothesis 1a (Improved Health-related Self-efficacy) was measured primarily by the Self-rated Abilities for Health Practices scale (SAHP) (Table 2). The data showed a significant improvement in the Workshop group's scores on this scale (p=0.03), while the Control group had no significant change from baseline to final administration of the instrument (p=0.88).

Hypothesis 1b (Improved Nutritional Awareness and Behavior) was measured primarily by the Nutrition sub-scale from the Health Promoting Lifestyle Practices-II (HPLP) scale (Table 2). There was a statistically significant improvement in the HPLP Nutrition sub-scale mean score for the Workshop group (p=0.01), while the Control group showed no change (p=0.57).

Hypothesis 1c (Increased Use of Stress Management Techniques) was measured by the HPLP Stress Management sub-scale and the Perceived Stress Scale (PSS). The HPLP Stress Management sub-scale showed a significant improvement in mean scores for the Workshop group (p=0.001) and no change for the Control group (p=0.97) (Table 2). The PSS mean score for the Workshop group was significantly improved (indicating less perceived stress) at the end of the project (p=0.04), while the mean score for the Control group indicated no significant changes in stress (p=0.40).

Hypothesis 1d (Improved Physical Fitness) was measured by a variety of scales and clinical variables. The HPLP Physical Activity sub-scale mean score was significantly improved from baseline to final measurement for the Workshop group (p=0.001), with no change for the Control group (p=0.57) (Table 2), indicating the workshops had a measurable positive impact on the physical activity level of the Workshop group. The Physical Activity with Disability Survey (PADS) is a more extensive and detailed measure of the day-to-day physical activities of the person with disabilities. The PADS Total Activity scale and its sub-scales showed no significant change for both the Workshop and Control groups over the course of the project (Workshop p=0.89, Control p=0.44).

Table 2. Socio-Psychological Data Related to Hypothesis 1

* Significant p-values (<0.05) are in bold type. Workshop group n=23, control group n=21.

The biometric variables related to Hypothesis 1d showed no significant changes over the course of the study (Table 3). Body Mass Index measurements (BMI = weight in kg / the squared height in meters) showed no change for either group over the course of the project. Physical endurance or aerobic capacity was estimated with an arm ergometer test, providing measurements of estimated peak VO2 in ml/minute, total work expended during the test in kp/m, and total exercise time to exhaustion in seconds. Although the Workshop group showed some encouraging trends toward improvement in all three of these measures, none of the changes reached statistical significance for either group. The blood parameters (total cholesterol, triglycerides, HDL, LDL, TC/HDL ratio) also showed no significant differences between the groups at the end of the study. (Total cholesterol was the only blood variable that was measured from baseline to final clinical sessions; the others were not measured until the post-workshop clinical sessions, and therefore these analyses were done as independent t-tests of the data from the final clinical session comparing the Workshop and the Control groups.)Table 3.

Biometric Data Related to Hypothesis 1d

* Significant p-values (<0.05) are in bold type. Workshop group n=23, control group n=21.
** Comparisons are for Workshop vs Control groups using data from final clinical session.

Hypothesis 2: Program participation will reduce health risk behaviors for secondary conditions associated with SCI.

Hypothesis 2 (Reduced Health Risk Behaviors for Secondary Conditions) was not directly measured by any of the variables used in this data set, since none of the measured behaviors were specific health risk behaviors that could be tied directly to specific secondary conditions. However, indirect measures could be developed using variables in the database. The two measures that were synthesized for this purpose involved baseline/final difference scores for the HPLP, the Secondary Conditions Scale, and for summary scores for questions from the U-M Health Risk Assessment (HRA) that measured changes for seven health behaviors. The U-M HRA questions asked whether the individual had intentionally made any of the following changes during the previous three months: 1) exercised more; 2) lost weight; 3) reduced alcohol use; 4) quit or cut down smoking; 5) reduced fat/cholesterol intake; 6) coped better with stress; and 7) lowered blood pressure. All seven of these health behaviors, if not appropriately maintained, could increase risk for one or more secondary conditions. For this analysis, the items were scored as a 1 if the individual indicated they had made such a change in the previous three months or did not need to make any change (i.e., they had adopted or maintained a healthy behavior), and 0 if they had not made any change (i.e., acknowledged they needed to make a change, but had not done so). Sum scores across the seven items were used to generate baseline/final difference scores. Difference scores also were generated for baseline/final sum scores for the HPLP and Secondary Conditions Scale. To indirectly demonstrate reduced health risk behaviors for secondary conditions (Hypothesis 2), an attempt was made to link the improvement in health behaviors (measured by the sum scores for the HPLP and the seven HRA health behaviors) with an improvement in the incidence and severity of secondary conditions (the sum scores for the Secondary Conditions Scale). If there is such a link, the improvement in health behaviors over the course of the study (represented by the baseline/final difference scores for the HPLP and the HRA items) should be negatively and significantly correlated with reductions in occurrence and intensity of secondary conditions (represented by baseline/final difference scores in the Secondary Conditions Scale).

As shown in Table 4, the correlation of the secondary conditions difference scores with the HPLP difference scores, while in the expected negative direction, was not significant. However, the correlation of the secondary conditions difference scores with the HRA health behaviors items, which can be considered a more specific measure for the purposes of measuring Hypothesis 2, was significant and in the expected negative direction.

Table 4. Data Related to Hypothesis 2

* Significant p-values (<0.05) are in bold type. Workshop group n=23, control group n=21.