Effect of Training for an Athletic Challenge on Illness Cognition in Individuals with Chronic Disability: A Prospective Cohort Study

Abstract

Illness cognitions (IC) influence how a patient adapts to a chronic disease. The aim was (1) to determine if training for a handcycling mountain time trial (HandbikeBattle) improves IC and (2) to identify factors associated with IC change scores. Persons with a chronic disability (N = 220; including N = 151 with spinal cord disorder) trained 5 months and participated in the time trial. The IC Questionnaire measured helplessness, acceptance, perceived benefits and was assessed before training (T1), after training (T2), and four months after the event (T3). Age, sex, body mass index (BMI), time since injury (TSI), disability characteristics, self-efficacy, mental health (MH) and musculoskeletal pain were obtained at T1. Multilevel regression analyses showed that helplessness decreased (from 11.96 to 11.28, p < 0.01) and perceived benefits increased (from 16.91 to 17.58, p < 0.01) from T1 to T2. For helplessness this decrease persisted during follow-up (11.16 at T3). Changes in helplessness were associated with self-efficacy (p = 0.02), MH (p = 0.02) and lesion completeness (p = 0.02), and were independent of disability type (p = 0.66), lesion level (p = 0.30) and demographics such as sex (p = 0.29) and age (p = 0.67). Training with peers may improve helplessness and perceived benefits in individuals with a chronic disability. Especially individuals with MH problems might benefit from training for an athletic challenge with peers to improve illness cognitions, and ultimately, quality of life.

Keywords: adaptive sport; appraisals; exercise; longitudinal study; psychological adaptation; spinal cord injury; wheelchair.

Figure 1

Study design. Measurements are performed at the start of the training period (January, T1); after the training period, prior to the event (June, T2); and follow-up, four months after the event (October/November, T3).

Figure 2

Longitudinal trajectory of helplessness with interaction effects. (a): Helplessness for a participant with a self-efficacy score of 30 (low self-efficacy) versus a participant with a self-efficacy score of 70 (high self-efficacy). (b): Helplessness for participants with mental health problems (0) versus participants without mental health problems (1). (c): Helplessness for participants with a motor complete spinal cord injury (0) versus participants with a motor incomplete spinal cord injury (1).

Figure 2

Longitudinal trajectory of helplessness with interaction effects. (a): Helplessness for a participant with a self-efficacy score of 30 (low self-efficacy) versus a participant with a self-efficacy score of 70 (high self-efficacy). (b): Helplessness for participants with mental health problems (0) versus participants without mental health problems (1). (c): Helplessness for participants with a motor complete spinal cord injury (0) versus participants with a motor incomplete spinal cord injury (1).