Wheelchair Hockey Linked to Physical, Psychological Gains in Men

Marta Figueiredo, PhD avatar

by Marta Figueiredo, PhD |

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A child in a wheelchair shows an ability to quickly raise his arms above his head.

Playing wheelchair hockey is associated with better psychological well-being, self-perception of physical abilities, and quality of life in men with spinal muscular atrophy (SMA) and Duchenne muscular dystrophy (DMD), a small study in Italy shows.

These findings add to some previous studies reporting the health benefits of adaptive sports to people with physical disabilities, including SMA, further supporting their participation in such sports.

The study, “Wheelchair Hockey improves neuromuscular patients’ well-being,” was published in the journal PM&R.

The benefits of physical activities and sports “have been highlighted in both the general population and among people affected by disabilities,” the researchers wrote.

Besides improving muscle strength and endurance, they help to lessen psychological problems like depression and anxiety, improve well-being and self-perception, and facilitate social contact, friendships, and community reintegration.

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However, “few studies have specifically investigated the effects of participation in adaptive sports on quality of life of patients affected by a neuromuscular disease,” the researchers wrote.

A team of researchers at the Niguarda Ca’ Granda Hospital’s Neuromuscular Omnicenter (NEMO), in Milan, evaluated the effects of wheelchair hockey — which is fairly common in Italy — on the quality of life of men with SMA and Duchenne MD.

Their study involved 14 men with SMA (11 with type 2, three with type 3) and 11 men with DMD; all used a wheelchair and neither had signs of cognitive impairment. All patients were being followed at NEMO.

A total of 15 participants — nine with SMA and six with DMD — played wheelchair hockey (sports group), while 10 others — five with each disease — who had never played adaptive sports served as a control group. In this adaptive team sport, players use electric wheelchairs and a longer stick to control the hockey ball from a seated position.

Participants’ median age was 22.9 in the sports group and 24.7 years in the control group. There were no significant group differences in terms of demographic and clinical features.

Quality of life was assessed using the Quality of Life index, which covers four domains: health and functioning, socioeconomic aspects, psychological/spiritual issues, and family context. Higher scores indicate better quality of life, and a difference of two or three points is considered to be clinically relevant.

As secondary goals, the researchers evaluated differences in physical self-efficacy and coping strategies. Physical self-efficacy refers to a person’s belief and confidence in their ability to successfully perform a given activity.

Physical self-efficacy was assessed with the Physical Self-Efficacy scale, which covers perceived physical ability and physical self-perception confidence. Five coping strategies, including social support, avoidance, positive attitude, problem-solving, and self-transcendence were evaluated using the Coping Orientation to the Problems Experienced questionnaire.

When adjusted for potential influencing factors, including age and underlying disease, results showed that wheelchair hockey players reported a significant, 4.4-point higher score on the Quality of Life Index compared with those who did not play adaptive sports.

These quality-of-life gains were mostly driven by improvements in the health/functioning and psychological/spiritual domains, reflecting 5.7-point higher scores relative to the control group.

Wheelchair hockey was also associated with significantly better physical self-efficacy, more specifically with better perceived physical ability.

The lack of a significant link between the adaptive sport and physical self-perception confidence may be due to the fact that neuromuscular diseases “affect the patients’ physical appearance in a specific … way, that could reduce physical aspect confidence,” the researchers wrote.

No group differences were detected in terms of coping strategies.

These findings highlight “a significant association between participation in wheelchair hockey and improved physical and psychological well-being of people affected by neuromuscular diseases, compared to those who are not involved in adaptive sports,” the researchers wrote.

As such, these data emphasize “the importance of sport activities especially adaptive ones (e.g., wheelchair hockey) as part of the patients’ care intervention,” they added.

Larger studies, including females and assessing why and how long a patient has played the sport, are needed to achieve “a more comprehensive understanding on the relations between sport participation and quality of life of people with disability,” the team wrote.

Researchers also noted that further studies should explore the effects of adaptive sports on patients’ physical features, such as fatigue, fitness, and mobility.

Given that this study provided a snap-shot of these patients’ well-being at a given moment, it is impossible to know whether “better quality of life and higher self-efficacy were determined by participation in adaptive sports, or rather participants with higher levels of quality of life and self-efficacy were more likely to participate in such activities,” the researchers wrote.

“Experimental and longitudinal studies could be more effective in detecting this causal relation and should thus be pursued for further understanding the topic,” they concluded.