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LaVela SL, Berryman K, Kale I, Farkas GJ, Henderson GV, Rosales V, Eisenberg D, Reyes L. Potential barriers to the use of anti-obesity medications in persons with spinal cord injuries and disorders. Obes Sci Pract 2024; 10:e784. [PMID: 39140098 PMCID: PMC11319924 DOI: 10.1002/osp4.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/01/2024] [Accepted: 07/23/2024] [Indexed: 08/15/2024] Open
Abstract
Background Anti-obesity medications (AOMs) may provide a viable option for obesity management. However, little is known about the use of AOMs in persons with SCI/D. Objective Describe health care providers' (HCPs) views about barriers to AOM use in persons living with SCI/D. Methods Descriptive qualitative design using in-depth interviews Descriptive statistics were used to calculate demographic and employment characteristics. Interviews were audio-recorded and transcribed verbatim. Transcripts were coded and analyzed using Braun and Clarke's (2006) six thematic analysis phases. Results HCPs (n = 12) were from 11 different nationwide facilities. Most HCPs were male (75%), a large majority were white (67%), and most were 26-49 years of age. Participants were dietitians (75%), physicians (17%), and psychologists (8%). HCPs ranged from 1.5 to 15 years of providing SCI/D care. HCPs described four main thematic barriers to AOM use in persons with SCI/D: (1) AOM side effects that are especially concerning in persons with SCI/D; (2) AOMs contribute to poor eating habits; (3) availability, accessibility, and administration; and (4) lack of evidence, clinical agreement, and knowledge about AOM use in the SCI/D population. Conclusions There are several potential barriers to AOM use in the SCI/D population. Barriers include AOM side effects which may cause or exacerbate conditions that are already concerns in persons with SCI/D, such as bowel and skin problems, and muscle loss. SCI/D HCPs reported a lack of evidence about AOM use in persons with SCI/D, but interest in obtaining more knowledge.
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Affiliation(s)
- Sherri L. LaVela
- Department of Veterans AffairsCenter of Innovation for Complex Chronic Healthcare (CINCCH)Edward Hines Jr. VA HospitalHinesIllinoisUSA
- Department of Physical Medicine and RehabilitationFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Kelsey Berryman
- Department of Veterans AffairsCenter of Innovation for Complex Chronic Healthcare (CINCCH)Edward Hines Jr. VA HospitalHinesIllinoisUSA
| | - Ibuola Kale
- Department of Veterans AffairsCenter of Innovation for Complex Chronic Healthcare (CINCCH)Edward Hines Jr. VA HospitalHinesIllinoisUSA
| | - Gary J. Farkas
- Department of Physical Medicine and RehabilitationUniversity of Miami Miller School of MedicineMiamiFloridaUSA
- Miami Project to Cure ParalysisUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Geoffrey V. Henderson
- Department of Physical Medicine and RehabilitationSUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | - Vanessa Rosales
- Department of Veterans AffairsCenter of Innovation for Complex Chronic Healthcare (CINCCH)Edward Hines Jr. VA HospitalHinesIllinoisUSA
| | - Dan Eisenberg
- Center for Innovation to ImplementationVA Palo Alto Health Care SystemPalo AltoCaliforniaUSA
- Stanford‐Surgery Policy Improvement Research & Education CenterStanford University School of MedicineStanfordCaliforniaUSA
| | - Lorena Reyes
- Department of Veterans AffairsCenter of Innovation for Complex Chronic Healthcare (CINCCH)Edward Hines Jr. VA HospitalHinesIllinoisUSA
- Nutrition and Food ServicesVA Edward Hines, Jr.HinesIllinoisUSA
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de Groot S, Adriaansen JJE, Stolwijk-Swüste JM, Osterthun R, van den Berg-Emons RJG, Post MWM. Obesity in wheelchair users with long-standing spinal cord injury: prevalence and associations with time since injury and physical activity. Spinal Cord 2024; 62:378-386. [PMID: 38649757 DOI: 10.1038/s41393-024-00995-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
STUDY DESIGN Secondary analysis of cross-sectional data from the ALLRISC cohort study. OBJECTIVES To investigate the prevalence of obesity and its association with time since injury (TSI) and physical activity (PA) in wheelchair users with long-standing (TSI > 10 years) spinal cord injury (SCI). SETTING Community, The Netherlands. METHODS Wheelchair users with SCI (N = 282) in TSI strata (10-19, 20-29, and ≥30 years) and divided in meeting SCI-specific exercise guidelines or not. Waist circumference (WC) and body mass index (BMI) were assessed. Participants were classified as being obese (WC > 102 cm for men, WC > 88 cm for women; BMI ≥ 25 kg/m2) or not. Logistic regression analyses were performed to investigate the associations between obesity and TSI and PA. RESULTS Almost half of the participants (45-47%) were classified as obese. TSI was significantly associated with obesity, the odds of being obese were 1.4 higher when having a 10 years longer TSI. Furthermore, the odds of being obese were 2.0 lower for participants who were meeting the exercise guidelines. CONCLUSIONS The prevalence of obesity is high in people with long-standing SCI. Those with a longer TSI and individuals who do not meet the exercise guidelines are more likely to be obese and need to be targeted for weight management interventions.
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Affiliation(s)
- Sonja de Groot
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands.
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | | | - Janneke M Stolwijk-Swüste
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Spinal Cord Injury and Orthopedics, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Rutger Osterthun
- Rijndam Rehabilitation, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marcel W M Post
- De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Centre for Rehabilitation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
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LaVela SL, Wu J, Harris AH, Frayne SM, Nevedal AL, Arnow KD, Barreto NB, Davis K, Eisenberg D. Physical and emotional consequences of excess weight as experienced by individuals with spinal cord injuries. J Spinal Cord Med 2024; 47:412-422. [PMID: 36448929 PMCID: PMC11044741 DOI: 10.1080/10790268.2022.2097994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
CONTEXT/OBJECTIVE Excess weight has the potential to carry a substantial physical and emotional burden. A better understanding of perceived consequences of excess weight may facilitate the development of patient-centered programs and interventions to promote weight management efforts in persons with spinal cord injury (SCI). The study objective was to describe consequences of excess weight from the personal perspectives of individuals with SCI. DESIGN Descriptive qualitative design using in-depth semi-structured interviews and thematic analysis. SETTING Veterans Health Administration (VHA) SCI System of Care. PARTICIPANTS Individuals with SCI (n-33). OUTCOME MEASURES Key themes from thematic analysis. RESULTS Participants were male (61%), ranged from 29 to 84 years of age, and about half had tetraplegia (55%). Five themes were identified that demonstrate negative consequences of excess weight experienced by individuals with SCI, including: (1) physical health conditions (including chronic conditions and SCI secondary conditions), (2) physical symptoms (such as pain, discomfort, and fatigue), (3) movement challenges, (4) appearance-related concerns, and (5) emotional impacts. CONCLUSIONS Carrying excess weight is concerning to individuals with SCI and in terms of consequences such onset or exacerbation of chronic conditions, SCI secondary conditions, physical symptoms, e.g. pain, movement impairment (including hampered mobility, difficult transfers and self-care), image/appearance concerns (e.g. body image, clothing misfit), and negative emotions (e.g. unhappy, sad, depressed). Our findings may inform SCI healthcare providers about the consequences of excess weight as experienced by individuals with SCI, highlighting what matters most to persons with SCI and guiding a patient-centered approach to weight management in this population.
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Affiliation(s)
- Sherri L. LaVela
- Center of Innovation for Complex Chronic Care, VA Edward Hines Jr., Hines, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Justina Wu
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Alex H.S. Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Susan M. Frayne
- Center of Innovation for Complex Chronic Care, VA Edward Hines Jr., Hines, Illinois, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Andrea L. Nevedal
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Katherine D. Arnow
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Nicolas B. Barreto
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Kristen Davis
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
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Patsakos EM, Bailey KA, Ditor DS. Exploring the Lived Experiences of Individuals With Spinal Cord Injury During the COVID-19 Pandemic. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241226827. [PMID: 38263725 PMCID: PMC10807388 DOI: 10.1177/00469580241226827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/09/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024]
Abstract
The global spread of severe acute respiratory syndrome coronavirus 2019 (COVID-19) has affected over 100 countries and has led to the tragic loss of life, overwhelmed health care systems and severely impacted the global economy. Specifically, individuals living with spinal cord injury (SCI) are particularly vulnerable during the COVID-19 pandemic as they often face adverse impacts on their health, emotional well-being, community participation, and life expectancy. The objective of this study was to investigate the lived experience of individuals with SCI during the COVID-19 pandemic in Ontario, Canada. An exploratory design with a qualitative descriptive approach was used to address the study objective. Nine semi-structured interviews were conducted with individuals with traumatic and non-traumatic SCI (37-69 years, C3-L5, AIS A-D, and 5-42 years post-injury). Using reflexive thematic analysis, the following themes were created: (1) Caregiver exposure to COVID-19; (2) Staying physically active in quarantine; (3) Living in social isolation; (4) Difficulty obtaining necessary medical supplies; (5) Access to health services and virtual care during COVID-19; and (6) Fighting COVID-19 misinformation. This is one of the first studies to explore the impact of COVID-19 on individuals living with SCI in Ontario. This study contributes to a greater understanding of the challenges faced by individuals living with SCI and provides insight into how to better support and respond to the specific and unique needs of individuals with SCI and their families during a national emergency or pandemic.
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Affiliation(s)
| | | | - David S. Ditor
- Brock University, St. Catharines, ON, Canada
- Brock-Niagara Centre for Health and Well-being, St. Catharines, ON, Canada
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Biduski GM, Knihs DA, Nery de Oliveira S, Hoinaski LP, Rossato M, Freitas CDLR. Magnitude and direction of elbow torque asymmetries in manual wheelchair users. Front Sports Act Living 2023; 5:1239626. [PMID: 37745200 PMCID: PMC10514472 DOI: 10.3389/fspor.2023.1239626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
The aims of the present study are to investigate the magnitude and direction of the elbow torque asymmetries in manual wheelchair users and to verify the agreement levels of the asymmetry's direction between different velocities and contraction modes in the isokinetic test. The sample was composed of 14 manual wheelchair users (four women, 10 men). The peak torque of the elbow flexors and extensors were measured on the dominant and non-dominant limbs, using a set of concentric/eccentric contractions at speeds of 60° s-1 and 180° s-1. Asymmetries were calculated by a specific equation, and the levels of agreement of the asymmetry's direction were calculated using Kappa coefficient. The main results showed a large variability in the magnitude of the asymmetries, ranging from -73.1% (ND) to 59.9% (D) between participants. The agreement levels of the elbow flexors and extensors between the different contraction modes were great (k = 0.71-0.85) for most of the velocities [except for flexors of 60° s-1 (k = 0.29)], but the agreement levels were only slight to fair (k = 0.16-0.31) for most of the contraction modes when comparing between velocities [except for flexors eccentric (k = 0.71)]. In conclusion, the elbow torque asymmetries are highly variable between subjects in terms of magnitude. In addition, in general, the limb favored by the asymmetry is the same when comparing between velocities, but not when comparing between contraction modes.
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Affiliation(s)
- Grazieli Maria Biduski
- Laboratory of Biomechanics, Sport Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Débora Aparecida Knihs
- Laboratory of Biomechanics, Sport Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Silas Nery de Oliveira
- Laboratory of Biomechanics, Sport Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Laís Peixoto Hoinaski
- Laboratory of Biomechanics, Sport Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Mateus Rossato
- Laboratory of Human Performance, Faculty of Physical Education and Physiotherapy, Federal University of Amazonas, Manaus, Brazil
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Pedersen JP, Ehrlich-Jones LS, Heinemann AW, LaVela SL. Informal Caregivers' Perceptions of Facilitators of Successful Weight Management for People With Spinal Cord Injury. Am J Occup Ther 2023; 77:7703205110. [PMID: 37379063 PMCID: PMC10321685 DOI: 10.5014/ajot.2023.050093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
IMPORTANCE Informal caregivers have valuable insights that occupational therapists can use to prevent and manage problems that may arise in people with spinal cord injury (SCI) because of a lack of physical activity and poor nutrition. OBJECTIVE To assess caregiver-identified facilitators of weight management in people with SCI. DESIGN Descriptive qualitative design using semistructured interviews and thematic analysis. SETTING Regional SCI Care Model System and Veterans Health Administration. PARTICIPANTS Informal caregivers (n = 24) of people with SCI. OUTCOMES AND MEASURES Facilitators of successful weight management in care recipients with SCI. RESULTS Four themes were identified as weight management facilitators: healthy eating (subthemes: food content, self-control, self-management, and healthy preinjury lifestyle), exercise and therapy (subthemes: occupational and physical therapy, receiving assistance, and resources for exercise), accessibility, and leisure activity or activities of daily living, the latter described as a source of activity (because of required energy expenditure) to facilitate weight management for people with more severe injuries. CONCLUSIONS AND RELEVANCE These findings can inform the development of successful weight management plans by occupational therapists by incorporating feedback from informal caregivers. Because caregivers are involved in many of the facilitators identified, occupational therapists should communicate with the dyad about sourcing accessible places to increase physical activity and assessing in-person assistance and assistive technology needs to promote healthy eating and physical activity. Occupational therapists can use informal caregiver-identified facilitators of weight management to help prevent and manage problems for people with SCI secondary to limited activity and poor nutrition. What This Article Adds: Occupational therapy practitioners provide therapeutic intervention to people with SCI; this includes attention to weight management from the time of initial injury throughout their lives. This article is novel in the presentation of informal caregivers' perceptions about successful facilitators of weight management among people with SCI, which is important because caregivers are intimately involved in the daily activities of people with SCI and can be a liaison for occupational therapists and other health care providers about ways to facilitate healthy eating and physical activity.
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Affiliation(s)
- Jessica Presperin Pedersen
- Jessica Presperin Pedersen, OTD, MBA, is Research Scientist, Shirley Ryan AbilityLab, Chicago, IL, and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL;
| | - Linda S Ehrlich-Jones
- Linda S. Ehrlich-Jones, PhD, RN, is Associate Director, Center for Rehabilitation Research, Shirley Ryan AbilityLab, Chicago, IL, and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Allen W Heinemann
- Allen W. Heinemann, PhD, is Director, Center for Rehabilitation Research, Shirley Ryan AbilityLab, Chicago, IL, and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sherri L LaVela
- Sherri L. LaVela, PhD, MPH, MBA, is Research Health Scientist, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, and Center of Innovation for Complex Chronic Healthcare, Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL
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Maher JL, Whitmarsh C, Smith P, Taylor H, Fard A, Bilzon J. Feasibility study of high-intensity interval training to reduce cardiometabolic disease risks in individuals with acute spinal cord injury. BMJ Open 2023; 13:e068507. [PMID: 36737096 PMCID: PMC9900054 DOI: 10.1136/bmjopen-2022-068507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Individuals ageing with spinal cord injury (SCI) experience an accelerated trajectory of diseases and disorders, such as cardiovascular disease and diabetes, that resemble those experienced with ageing alone. Currently, an evidence-based approach toward managing this problem does not exist and therefore the purpose of this study is to determine the feasibility of conducting a high-intensity exercise intervention in individuals with acute (<6 months postinjury) SCI to improve cardiometabolic health. METHODS AND ANALYSIS We will conduct a single-centre, two parallel-arm, randomised feasibility study of a high-intensity interval training (HIIT) intervention in individuals with acute SCI. We will enrol 40 individuals (20 intervention, 20 control) with acute SCI attending inpatient rehabilitation at Salisbury District Hospital. Participants will be randomly allocated to the intervention group (HIIT) or control group for 18 weeks. Both groups will participate in standard care throughout the duration of the study. The HIIT group only will also perform supervised HIIT exercise on an arm cycle ergometer three times per week. Over the course of the intervention, most participants will be discharged from the hospital, and at this time, an arm cycle ergometer will be installed in their home and the intervention will transition into outpatient care. We will assess cardiorespiratory fitness, glycaemic control, lipid profile and body habitus as well as qualitative assessments of acceptability at weeks 0, 9 and 18 with the primary outcome being the feasibility of a full Randomised Controlled Trial (RCT). ETHICS AND DISSEMINATION This study will inform a longer-term, definitive, multicentre RCT to establish the impact of this exercise intervention in maintaining the cardiometabolic health of patients during the acute phase following SCI. Results will be disseminated in different formats including peer-reviewed journal articles, conference presentations and internet media, to a wide audience including clinicians, researchers and individuals with SCI. TRIAL REGISTRATION NUMBER ISRCTN57514022.
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Affiliation(s)
| | - Catherine Whitmarsh
- Duke of Cornwall Spinal Treatment Centre, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Paula Smith
- Department of Psychology, University of Bath, Bath, UK
| | - Hazel Taylor
- Research Design Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Aram Fard
- Duke of Cornwall Spinal Treatment Centre, Salisbury NHS Foundation Trust, Salisbury, UK
| | - James Bilzon
- Department for Health, University of Bath, Bath, UK
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LaVela SL, Wu J, Nevedal AL, Harris AHS, Frayne SM, Arnow KD, Barreto NB, Davis K, Eisenberg D. The impact of the COVID-19 pandemic on individuals living with spinal cord injury: A qualitative study. Rehabil Psychol 2023; 68:12-24. [PMID: 36395055 PMCID: PMC10593179 DOI: 10.1037/rep0000469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE/OBJECTIVE To explore the impact of the COVID-19 pandemic as experienced and reported by individuals living with a spinal cord injury (SCI). RESEARCH METHOD/DESIGN Descriptive qualitative design using in-depth semistructured interviews with individuals with SCI (n = 33) followed by thematic analysis. RESULTS Three main themes described impacts of the COVID-19 pandemic. (a) Impact on health care use; subthemes elaborated that this was attributable to in-person health care facility restrictions or individual decisions to delay care. Individuals with SCI experienced lapses in primary and SCI-specialty care, rehabilitation/therapy services, and home care, but some made use of telehealth services. (b) Impact on weight and/or weight management lifestyle behaviors; subthemes discussed that engagement in physical activity declined because of fitness center closures, recreational activity cancellations, and safety precautions limiting community-based and outdoor activities. The pandemic disrupted participants' independence in purchasing and making preferred food selections which impacted healthy eating. Participants ate due to boredom, at nonmealtimes, and consumed unhealthy foods during the pandemic. (c) Impact on psychosocial factors; included subthemes noting reduced social interactions, social participation, and ability to pursue pastimes with family, friends, and groups they belonged to. The pandemic also triggered emotional reactions such as worry, fear, doubt, demotivation, and feelings of social isolation. CONCLUSIONS Our findings highlight the magnitude of consequences faced by individuals with SCI when restrictions to health care, healthy lifestyle endeavors, and social participation occurred during the COVID-19 pandemic. Findings may inform SCI health care providers on what is needed in response to future public health or natural disaster crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Sherri L. LaVela
- Center of Innovation for Complex Chronic Healthcare, Department of Veterans Affairs, Edward Mines Jr. VA Hospital, Hines, Illinois, United Slates
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University
| | - Justina Wu
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, United States
| | - Andrea L. Nevedal
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, United States
| | - Alex H. S. Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, United States
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine
| | - Susan M. Frayne
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, United States
- Department of Medicine, Stanford University School of Medicine
| | - Katherine D. Arnow
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine
| | - Nicolas B. Barreto
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine
| | - Kristen Davis
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine
| | - Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, United States
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine
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LaVela SL, Burkhart E, Jones K, Pellegrini C. Health care provider views on the magnitude of overweight/obesity in spinal cord injury and awareness of evidence-based guidance for weight management. PM R 2023; 15:20-30. [PMID: 34534402 DOI: 10.1002/pmrj.12709] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/02/2021] [Accepted: 09/10/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Literature shows that large proportions of people with a spinal cord injury (SCI) continue to experience challenges and limitations in weight management (WM) efforts in the health care setting. Despite the need, evidence-based research on effective and practical WM practices for persons with SCI is inconsistent and not widely used by health care providers (HCPs). OBJECTIVE The objectives were twofold: (1) to explore HCP perspectives of the extent of the problem of overweight/obesity in individuals with SCI and (2) HCPs awareness of and beliefs about availability of literature or evidence-based guidelines that discuss WM in SCI. DESIGN Qualitative study using semistructured interviews with HCPs and thematic analysis to identify themes. PARTICIPANTS/SETTING SCI HCPs (n = 25) from Veterans Health Administration and Midwest Regional SCI Care System. INTERVENTION Not applicable. RESULTS SCI HCPs (88%) emphasized the large scope of the problem of overweight and obesity in persons with SCI. HCPs noted the multiple associated negative consequences, specifically 84% highlighted the impact on chronic conditions (cardiometabolic, respiratory) and 48% discussed the impact on secondary/associated conditions (skin, bowel, bladder, musculoskeletal). HCPs noted other impacts of excess weight as greater disability in later life (28%), challenges with mobility and function (60%), self-care (24%), and equipment safety (28%). This sample of HCPs (76%) indicated being unaware of published or available information about WM efforts that work in SCI populations. CONCLUSION Our findings indicate that HCPs believe that overweight and obesity is a significant problem in persons with SCI but that this sample of HCPs are not aware of published work and easily accessible SCI-specific WM evidence-based guidance. This suggests the need for more education and proactive efforts to improve awareness of appropriate information within interprofessional HCPs.
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Affiliation(s)
- Sherri L LaVela
- Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Elizabeth Burkhart
- Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines, Illinois, USA.,Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois, USA
| | - Kayla Jones
- Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, Illinois, USA
| | - Christine Pellegrini
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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LaVela SL, Pellegrini C, Heinemann AW, Ehrlich-Jones LS, Bartle B, Burkhart L, Pederson J. Development and evaluation of an educational curriculum for healthcare providers on overweight/obesity management in individuals with spinal cord injury based on diverse stakeholder engagement. Disabil Health J 2022; 15:101362. [PMID: 35970748 DOI: 10.1016/j.dhjo.2022.101362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/13/2022] [Accepted: 07/01/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Spinal cord injury (SCI) healthcare providers are aware of the harmful consequences of overweight/obesity in persons with SCI, but many are unaware of available information and lack training to guide weight management care in the SCI population. OBJECTIVE Describe the development and content of an educational curriculum for healthcare providers to help individuals with SCI prevent or manage overweight/obesity. METHODS The biopsychoecological framework guided curriculum planning, data collection, and product development. Thematic analysis of interviews conducted with individuals with SCI, informal caregivers, and SCI healthcare providers pinpointed central educational curriculum topics. SCI healthcare providers evaluated the curriculum. RESULTS Seven comprehensive topics were developed: 1. Scope and consequences of overweight/obesity in SCI; 2. Classifying and measuring overweight/obesity in SCI; 3. Guidelines related to weight management in SCI; 4. Identifying challenges (and solutions) to weight management in SCI; 5. Strategies for providers to facilitate weight management; 6. Understanding goals, motivators, and desired feedback for weight management; and 7. Knowing how informal caregivers are affected by weight and weight management of care recipients with SCI. High ratings (>80% strong agreement) were achieved on content, word choice, organization, relevance, and actionability. Modification needs were identified and subsequently made to layout, visual aids, and provision of tangible resources. Providers described the curriculum as a scientifically rigorous resource that addresses a knowledge gap, provides population-specific content, and is useful across interdisciplinary teams. CONCLUSION We developed a self-directed learning educational curriculum addressing topics most salient to stakeholders involved in overweight/obesity management of persons with SCI.
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Affiliation(s)
- Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Christine Pellegrini
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, IL, USA
| | - Linda S Ehrlich-Jones
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, IL, USA
| | - Brian Bartle
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Lisa Burkhart
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA; Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
| | - Jessica Pederson
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, IL, USA
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11
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LaVela SL, Pedersen J, Ehrlich-Jones L, Heinemann AW. Informal caregivers' self-identified roles in facilitating health-promoting behaviours for weight management in community-dwelling care recipients living with spinal cord injury in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1585-e1598. [PMID: 34595792 DOI: 10.1111/hsc.13585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/20/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
Health providers often focus on secondary conditions and spend less time prioritising overweight/obesity care. Informal caregivers are well positioned to facilitate health-promoting behaviours of healthy eating and physical activity among community-dwelling care recipients with spinal cord injury (SCI) for prevention and management of overweight/obesity. Literature has typically focused on caregiver adjustment post-injury and burden related to their roles in secondary condition care. The novel objective of this study was to describe informal caregivers' perspectives of their roles in facilitating health-promoting weight management behaviours, healthy eating and physical activity, for care recipients with SCI. This was a qualitative study that used semi-structured interviews with informal caregivers for data collection in 2019. Braun & Clarke's established thematic phases were used for analysis. Participants included informal caregivers of individuals with SCI living in the community (n = 24). Caregivers identified eight themes to describe their role in facilitating weight management for care recipients. Themes included: (1) meal planning/shopping, (2) meal preparation/cooking, (3) using portion control, (4) serving/feeding, (5) helping the care recipient with physical activity and/or leisure activities, (6) mutually participating in weight management activities, (7) providing motivation and encouragement and (8) being an information liaison. In summary, informal caregivers have an intimate understanding of care recipients' needs and have insights on obstacles and enablers to health-promoting behaviours, making their involvement in facilitating weight management in individuals with SCI vital. Caregivers self-identified several significant roles for promoting weight management. This is especially valuable for conditions such as overweight/obesity for which prevention and treatment involve health-promoting behaviours that need consistent attention in the community setting. It is important to ensure that informal caregivers and care recipients have the information required in order to facilitate healthy eating and physical activity in persons with SCI and have opportunities for mutual dyadic participation when both partners are interested.
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Affiliation(s)
- Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jessica Pedersen
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, Illinois, USA
| | - Linda Ehrlich-Jones
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, Illinois, USA
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, Illinois, USA
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12
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Recent Updates in Nutrition After Spinal Cord Injury: 2015 Through 2021. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Wood S, Khong CM, Dirlikov B, Shem K. Nutrition counseling and monitoring via tele-nutrition for healthy diet for people with spinal cord injury: A case series analyses. J Spinal Cord Med 2022; 45:547-555. [PMID: 33606588 PMCID: PMC9246100 DOI: 10.1080/10790268.2021.1871824] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To evaluate the effect of a tele-nutrition counseling program on diet quality, weight, waist circumference, and quality of life in people with spinal cord injury (SCI). DESIGN Prospective observational study. PARTICIPANTS Fifteen participants with SCI were enrolled from an acute inpatient rehabilitation unit and outpatient SCI clinic; ten participants completed the intervention. INTERVENTIONS Six tele-nutrition counseling sessions over 3 months, utilizing videoconferencing and a photographic food diary. OUTCOME MEASURES Weight, waist circumference, Life Satisfaction Index A (LSIA), Knowledge and Nutrition Evaluation with Supplement on Eating Behavior, and Program Satisfaction Survey (PSS). RESULTS Ten participants completed both baseline and 3-month follow-up evaluations and were used in this analysis. There were no statistically significant changes from baseline to 3-month follow up in weight, waist circumference, Knowledge and Nutrition Evaluation, and LSIA (P > .48). Using the Supplement on Eating Behavior total score to measure overall changes in healthy food choices, 9 out of 10 participants rated their healthy food choices as improving (P = .008). A post-hoc exploratory itemized analysis on the Supplement on Eating Behavior revealed significant improvements from baseline to 3-month follow-up in participant's self-reported choice of balanced meals (P = .008), reading food labels (P = .031), logging meals (P = .007), and monitoring portions of eating favorite foods (P = .031). Participants endorsed a 97-100% satisfaction rating in relation to perceived health benefits, equipment, and program satisfaction. CONCLUSION This study provides preliminary data suggesting that tele-nutrition is an efficacious intervention that may improve diet quality for individuals with SCI.
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Affiliation(s)
- Shelley Wood
- Department of Nutrition and Food Services, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Cria-May Khong
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Benjamin Dirlikov
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Kazuko Shem
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California, USA,Correspondence to: Shelley Wood, Department of Nutrition and Food Services, Santa Clara Valley Medical Center, 751 South Bascom Avenue, San Jose, CA95128, USA; 408-885-2387; 408-885-4606.
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Wen H, DeVivo MJ, Heinemann AW, Krause JS, Robinson-Whelen S, Chen Y. Mortality Beyond the First Year After Spinal Cord Injury: Does Body Mass Index Matter? Arch Phys Med Rehabil 2021; 103:711-721. [PMID: 34800475 DOI: 10.1016/j.apmr.2021.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/22/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the association between body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) and mortality after the first year post spinal cord injury (SCI) overall and across demographic and injury characteristics. DESIGN Cohort study. SETTING Sixteen Spinal Cord Injury Model Systems (SCIMS) centers. PARTICIPANTS SCIMS Database participants age 20 years or older and having a BMI assessment during the 2007-2011 wave of data collection. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES All-cause mortality rate. Life table method and log-rank test were used to estimate and compare mortality rates across BMI groups and other factors. Cox proportional hazard regression model was conducted to estimate hazard ratio (HR) and 95% confidence interval (CI). RESULTS A total of 2346 participants (N=2346) with SCI were classified into 1 of the 8 BMI groups: <18.5 (6.9%), 18.5-19.9 (7.3%), 20.0-22.49 (15.0%), 22.5-24.9 (18.8%), 25.0-27.49 (17.5%), 27.5-29.9 (13.2%), 30.0-34.9 (13.5%), and ≥35.0 (7.8%). Compared with people with BMI of 22.5-29.9, a higher mortality risk was observed among people with BMI<18.5 (HR, 1.76; 95% CI, 1.25-2.49), 18.5-19.9 (HR, 1.51; 95% CI, 1.06-2.15), and ≥35.0 (HR, 1.51; 95% CI, 1.11-2.07) after adjusting for confounding factors (sex, age at the time of BMI assessment, marital status, neurologic status). The U-shape BMI-mortality relationship varied by age, sex, neurologic status, and years since injury. CONCLUSIONS To improve life expectancy after SCI, health care professionals could focus on weight management among patients with relatively low and extremely high BMI, defined by demographic and injury-related characteristics. Future studies should explore factors that contribute to such a higher mortality after SCI, including pre-existing conditions, poor diet and/or nutrition, and cardiorespiratory fitness.
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Affiliation(s)
- Huacong Wen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
| | - Michael J DeVivo
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Susan Robinson-Whelen
- TIRR Memorial Hermann, Houston, TX; Baylor College of Medicine, Houston, TX; University of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL.
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15
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LaVela SL, Ehrlich-Jones LS, Jones K, Bartle B, Heinemann AW. What Are Personal Meanings of Healthy Eating and Physical Activity in Individuals Living With Spinal Cord Injury? A Qualitative Exploration. Top Spinal Cord Inj Rehabil 2021; 27:68-78. [PMID: 34866889 PMCID: PMC8604504 DOI: 10.46292/sci21-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives: To explore the personal meanings of healthy eating and physical activity among individuals living with spinal cord injury (SCI) and the information and resources they find beneficial. Methods: We conducted in-depth semistructured individual interviews to understand the personal meanings of healthy eating and physical activity among individuals with SCI. We completed a thematic analysis of qualitative data. Results: Participants were 11 Veterans and 14 civilians, predominantly male, non-Hispanic White, and with paraplegia. Data were described across two categories, including the personal meaning of healthy eating and the personal meaning of physical activity/exercise. Individuals with SCI described their meaning of healthy eating around four themes: types of food, amounts/portions of food, conscious/mindful eating, and eating to enhance health. Individuals wanted information on tailored diets for individuals with paraplegia and tetraplegia and healthy foods that are easy to prepare by people with SCI. Their personal meaning of physical activity/exercise focused on four themes: types of physical activity and exercise, staying active, moving/movement, and differences from non-SCI. Desired information around physical activity included cardiovascular workouts that are effective and possible to do in a wheelchair so that people with SCI can burn enough of the calories they consume to lose or maintain weight. Conclusion: Results provide a better understanding of what healthy eating and physical activity mean to people with SCI and information they desire toward these goals, which can be used to guide patient-provider discussions, develop health promotion programs, and tailor interventions to capitalize on meaningful concepts and beliefs that facilitate healthy behaviors.
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Affiliation(s)
- Sherri L. LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Linda S. Ehrlich-Jones
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, Illinois
| | - Kayla Jones
- Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, Illinois
| | - Brian Bartle
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois
| | - Allen W. Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Midwest Regional SCI Care System (MRSCICS), Shirley Ryan AbilityLab (SRAlab), Chicago, Illinois
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Raguindin PF, Bertolo A, Zeh RM, Fränkl G, Itodo OA, Capossela S, Bally L, Minder B, Brach M, Eriks-Hoogland I, Stoyanov J, Muka T, Glisic M. Body Composition According to Spinal Cord Injury Level: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10173911. [PMID: 34501356 PMCID: PMC8432215 DOI: 10.3390/jcm10173911] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 12/17/2022] Open
Abstract
The level of injury is linked with biochemical alterations and limitations in physical activity among individuals with spinal cord injury (SCI), which are crucial determinants of body composition. We searched five electronic databases from inception until 22 July 2021. The pooled effect estimates were computed using random-effects models, and heterogeneity was calculated using I2 statistics and the chi-squared test. Study quality was assessed using the Newcastle–Ottawa Scale. We pooled 40 studies comprising 4872 individuals with SCI (3991 males, 825 females, and 56 sex-unknown) in addition to chronic SCI (median injury duration 12.3 y, IQR 8.03–14.8). Individuals with tetraplegia had a higher fat percentage (weighted mean difference (WMD) 1.9%, 95% CI 0.6, 3.1) and lower lean mass (WMD −3.0 kg, 95% CI −5.9, −0.2) compared to those with paraplegia. Those with tetraplegia also had higher indicators of central adiposity (WMD, visceral adipose tissue area 0.24 dm2 95% CI 0.05, 0.43 and volume 1.05 L 95% CI 0.14, 1.95), whereas body mass index was lower in individuals with tetraplegia than paraplegia (WMD −0.9 kg/mg2, 95% CI −1.4, −0.5). Sex, age, and injury characteristics were observed to be sources of heterogeneity. Thus, individuals with tetraplegia have higher fat composition compared to paraplegia. Anthropometric measures, such as body mass index, may be inaccurate in describing adiposity in SCI individuals.
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Affiliation(s)
- Peter Francis Raguindin
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland; (O.A.I.); (T.M.); (M.G.)
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
- Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
- Correspondence:
| | - Alessandro Bertolo
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
| | - Ramona Maria Zeh
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
| | - Gion Fränkl
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Oche Adam Itodo
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland; (O.A.I.); (T.M.); (M.G.)
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
- Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Simona Capossela
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine, Metabolism, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland;
| | - Beatrice Minder
- Public Health & Primary Care Library, University Library of Bern, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland;
| | - Mirjam Brach
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
| | - Inge Eriks-Hoogland
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
- Swiss Paraplegic Center, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland; (O.A.I.); (T.M.); (M.G.)
| | - Marija Glisic
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland; (O.A.I.); (T.M.); (M.G.)
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland; (A.B.); (R.M.Z.); (G.F.); (S.C.); (M.B.); (I.E.-H.); (J.S.)
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Wen H, DeVivo MJ, Mehta T, Kaur Baidwan N, Chen Y. The impact of body mass index on one-year mortality after spinal cord injury. J Spinal Cord Med 2021; 44:563-571. [PMID: 31729925 PMCID: PMC8288132 DOI: 10.1080/10790268.2019.1688021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective: Evaluate the association between body mass index (BMI, kg/m2) and one-year mortality among people who survived the first 90 days after spinal cord injury (SCI).Design: Cohort study.Setting: Eighteen SCI Model Systems centers throughout the United States.Participants: 6640 participants (men, 79.6%; mean age, 42.8 ± 17.7y; Whites, 62.3%) who had an SCI between October 2006 and March 2017.Interventions: Not applicable.Outcome Measures: All-cause mortality and causes of death. Life table method was used to estimate mortality rates, while Cox proportional hazard model was conducted to assess the impact of BMI on mortality after adjusting for demographic and injury-related factors.Results: Based on BMI obtained during initial rehabilitation, participants were classified into underweight (4.2%), normal weight (41.2%), overweight (30.9%) and obese (23.8%) groups, and their corresponding one-year mortality rates were 2.6%, 1.8%, 3.1%, 3.5%, respectively (P = 0.002). After adjusting for potential confounding factors, people with obesity had a higher mortality risk than those with normal weight (hazard ratio, 1.51; 95% confidence interval, 1.00-2.28). The most frequent causes of death for people with obesity were infective and parasitic diseases and respiratory diseases, while respiratory diseases were the most frequent for people with other BMI statuses.Conclusion: People with obesity who incur an SCI need special attention to prevent early mortality. Future studies should explore factors that contribute to such a higher mortality after SCI, such as preexisting conditions and comorbidities. The effects of BMI on long-term mortality also deserve further investigation.
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Affiliation(s)
- Huacong Wen
- Department of Physical Therapy, School of Health Professionals, University of Alabama at Birmingham, Birmingham, Alabama, USA,Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael J. DeVivo
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tapan Mehta
- Department of Health Services Administration, School of Health Professionals, University of Alabama at Birmingham, Birmingham, Alabama, USA,UAB-Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Alabama, USA
| | - Navneet Kaur Baidwan
- Department of Health Services Administration, School of Health Professionals, University of Alabama at Birmingham, Birmingham, Alabama, USA,UAB-Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Alabama, USA
| | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA,Correspondence to: Yuying Chen, Spain Rehabilitation Center, Room 515, 1717 Sixth Avenue South, Birmingham, AL35249-7330, USA; Ph: 205-934-3329.
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18
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Vives Alvarado JR, Felix ER, Gater DR. Upper Extremity Overuse Injuries and Obesity After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:68-74. [PMID: 33814884 DOI: 10.46292/sci20-00061] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Persons with spinal cord injury (SCI) are at high risk for developing neurogenic obesity due to muscle paralysis and obligatory sarcopenia, sympathetic blunting, anabolic deficiency, and blunted satiety. Persons with SCI are also at high risk for shoulder, elbow, wrist, and hand injuries, including neuromusculoskeletal pathologies and nociceptive pain, as human upper extremities are poorly designed to facilitate chronic weight-bearing activities, including manual wheelchair propulsion, transfers, self-care, and day-to-day activities. This article reviews current literature on the relationship between obesity and increased body weight with upper extremity overuse injuries, detailing pathology at the shoulders, elbows, and wrists that elicit pain and functional decline and stressing the importance of weight management to preserve function.
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Affiliation(s)
- Jose R Vives Alvarado
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Elizabeth R Felix
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.,Research Service, Miami Veterans Affairs (VA) Healthcare System, Miami, Florida
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.,The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
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19
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Health provider identified barriers and facilitators to weight management for individuals with spinal cord injury. Spinal Cord 2021; 59:1061-1071. [PMID: 33564116 PMCID: PMC8349924 DOI: 10.1038/s41393-021-00614-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/20/2022]
Abstract
Study Design: Qualitative descriptive study using semi-structured interviews Objective: The purpose of this study was to examine the barriers and facilitators of weight management in individuals with spinal cord injury (SCI) from the perspective of SCI health care providers. Setting: Veterans Health Administration and Midwest Regional SCI Care Systems Methods: Health care providers (n=25) who care for individuals with SCI completed semi-structured interviews. Thematic analysis methodology was used to identify emergent themes around barriers and facilitators to weight management in SCI. Results: Sixteen subthemes emerged for barriers and 7 subthemes emerged for facilitators for weight management in SCI. Barriers included individual-level factors (e.g., physical ability/mobility limitations, lack of interest, psychological obstacles, lack of knowledge, poor dietary strategies), socio-environmental factors (e.g., challenges with family support, lack of access to weight management resources, dependency on others, difficulties obtaining weight measurement), and organizational factors (e.g., lack of integration/ inconsistent weight management support from healthcare systems, pushing calorie intake early post-injury). Facilitators included individual-level factors (e.g., motivation, education/knowledge, participation in exercise and physical activity) and socio-environmental factors (e.g., positive support network, access to/use of healthy dietary strategies, access to exercise facilities/adaptive equipment, participating in weight management with others). Conclusions: Healthcare providers identified individual-level, socio-environmental, and organizational barriers and facilitators that influence weight management efforts in individuals with SCI. Future weight management resources and programs should consider addressing common barriers identified by healthcare providers, individuals with SCI, and their caregivers, and develop strategies to promote facilitators to enhance weight management in this population.
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20
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Yahiro AM, Wingo BC, Kunwor S, Parton J, Ellis AC. Classification of obesity, cardiometabolic risk, and metabolic syndrome in adults with spinal cord injury. J Spinal Cord Med 2020; 43:485-496. [PMID: 30620685 PMCID: PMC7480648 DOI: 10.1080/10790268.2018.1557864] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objective: To describe and compare (1) classification of obesity using clinical proxies of body composition that are easily accessible in the outpatient clinic setting, (2) cardiometabolic risk using existing screening tools and staging systems, and (3) the presence of metabolic syndrome (MetS) using four commonly-used definitions in adults with spinal cord injury (SCI). Design: Retrospective chart review Setting: Outpatient Veterans Affairs (VA) SCI Annual Evaluation Clinic Participants: Patients who attended an annual evaluation appointment with demographic, anthropometric, and biochemical data documented in their medical records as part of routine medical care. Outcome measures: Obesity classification (body mass index, waist circumference, ideal body weight percentage), cardiometabolic risk scores (Framingham Risk Score, Cardiometabolic Disease Staging System, Edmonton Obesity Staging System), and MetS classification (using four commonly-used definitions) were described and compared. Results: Of the 155 veterans included in this analysis, 93% were considered "at risk" by at least one of the measurements studied. However, there was considerable variation between the different screening tools. The κ-agreement between various definitions of MetS ranged from fair to moderate. Conclusion: Screening tools that were developed for the non-SCI population produced variable assessments of risk when applied to veterans with SCI. Due to the fair to moderate inter-rater agreement between MetS definitions, it is unknown which definition is superior to identify MetS in the SCI population. An SCI-specific screening tool is needed to accurately classify obesity, cardiometabolic risk, and MetS in order to provide timely education and intervention.
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Affiliation(s)
- Amy M. Yahiro
- Nutrition and Food Services, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois, USA,Correspondence to: Amy M. Yahiro, Nutrition and Food Services, Edward Hines, Jr. Veterans Affairs Hospital, 5000 South 5th Avenue, Hines, IL60141, USA.
| | - Brooks C. Wingo
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sujit Kunwor
- Department of Information Systems, Statistics, Management Science, University of Alabama, Tuscaloosa, Alabama, USA
| | - Jason Parton
- Department of Information Systems, Statistics, Management Science, University of Alabama, Tuscaloosa, Alabama, USA
| | - Amy C. Ellis
- Department of Human Nutrition and Hospitality Management, University of Alabama, Tuscaloosa, Alabama, USA
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Holla JFM, van den Akker LE, Dadema T, de Groot S, Tieland M, Weijs PJM, Deutekom M. Determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation: Perspectives of rehabilitation professionals and wheelchair users. PLoS One 2020; 15:e0228465. [PMID: 32004359 PMCID: PMC6993975 DOI: 10.1371/journal.pone.0228465] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/16/2020] [Indexed: 02/06/2023] Open
Abstract
Objective This study aims to identify determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation, from the perspectives of both wheelchair users and rehabilitation professionals. The findings should contribute to the field of health promotion programs for wheelchair users. Methods Five focus groups were held with wheelchair users (n = 25), and two with rehabilitation professionals (n = 11). A thematic approach was used for data analysis in which the determinants were categorized using an integrated International Classification of Functioning, Disability and Health and Attitude, Social influence and self-Efficacy model. Results Reported personal factors influencing dietary behaviour in wheelchair users were knowledge, boredom, fatigue, stage of life, habits, appetite, self-control, multiple lifestyle problems, intrinsic motivation, goal setting, monitoring, risk perception, positive experiences, suffering, action planning, health condition, function impairments, attitude and self-efficacy. Reported environmental factors influencing dietary behaviour in wheelchair users were unadjusted kitchens, monitoring difficulties, eating out, costs, unfavourable food supply, nutrition education/counselling, access to simple healthy recipes, eating together, cooking for others, and awareness and support of family and friends. Conclusions Important modifiable determinants of dietary behaviour in wheelchair users that might be influenced in lifestyle interventions are knowledge, fatigue, habits, self-control, intrinsic motivation, risk perception, attitude and self-efficacy. It is recommended to involve relatives, since they appear to significantly influence dietary behaviour.
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Affiliation(s)
- Jasmijn F. M. Holla
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Lizanne E. van den Akker
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
| | - Tessa Dadema
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Sonja de Groot
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
- University Medical Centre Groningen, Centre for Human Movement Sciences, University of Groningen, Groningen, The Netherlands
| | - Michael Tieland
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Peter J. M. Weijs
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Nutrition and Dietetics, Amsterdam University Medical Centres, VU University, Amsterdam, The Netherlands
| | - Marije Deutekom
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- * E-mail:
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Seated pressures in daily wheelchair and sports equipment: investigating the protective effects of cushioned shorts. Spinal Cord Ser Cases 2018; 4:47. [PMID: 29900009 DOI: 10.1038/s41394-018-0084-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/08/2018] [Accepted: 02/17/2018] [Indexed: 11/08/2022] Open
Abstract
Study design The primary study design was a pretest and posttest study performed in a single session with subjects as their own control. We summarize three integrated and sequential studies. Objective The objective of this study was to investigate whether commercially available cushioned shorts would add skin protection when used in adaptive sports equipment (AE). Setting Community in Tacoma Washington, USA. Methods TekScan Pressure Mapping System for recording average (AP) and peak (PP) seating pressures.Part 1. Pretest/posttest design, subjects as own control. Eight adults with SCI (C5-T6) mapped in daily wheelchair and AE with and without bicycle shorts.Part 2. Sixteen able-bodied subjects were mapped with and without an impact short and full-coverage short in a hand-cycle.Part 3. One individual with T5 SCI was mapped with and without a full-coverage short in personal basketball chair and mountain hand-cycle. Results Part 1. Significant differences between the daily wheelchair and AE in the static condition for AP and PP and AP in the dynamic condition. Bicycle shorts showed no significance.Part 2. Impact shorts increased static PP and AP. The full-coverage short decreased static AP.Part 3. The full-coverage short increased AP and PP in the basketball chair. In the mountain hand-cycle, AP decreased but PP increased. Conclusion Athletes who are static in their AE may be at greater risk of tissue breakdown than those actively playing. Cushioned shorts had highly variable effects on seated pressure in adaptive equipment. Pressure mapping is recommended prior to using any cushioning in AE by the SCI population.
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Wen H, Chen Y, He Y, Bickel CS, Robinson-Whelen S, Heinemann AW. Racial Differences in Weight Gain: A 5-Year Longitudinal Study of Persons With Spinal Cord Injury. Arch Phys Med Rehabil 2017; 99:1957-1964. [PMID: 29247628 DOI: 10.1016/j.apmr.2017.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess racial differences in body mass index (BMI) change over 5 years among people with spinal cord injury (SCI). DESIGN Multicenter longitudinal study. SETTING Spinal Cord Injury Model Systems centers. PARTICIPANTS Individuals (N=437; 313 non-Hispanic white, 81 non-Hispanic black, and 43 Hispanic; 335 men; mean age, 41.3±13.5y) who incurred an SCI from 1974 to 2010 and completed 2 follow-up assessments within 5 years between October 1, 2006 and September 18, 2015 (mean duration of injury, 9.1±9.6y at the start of the 5-year follow-up). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES BMI (in kilograms per meters squared). RESULTS The mean BMI of 437 participants increased from 26.4±6.3 to 27.0±6.4kg/m2 over 5 years (P=.002). The greatest increase was noted for Hispanics (2.0±5.7kg/m2; P=.02), followed by non-Hispanic whites (0.6±3.9kg/m2; P=.01) and non-Hispanic blacks (0.01±3.7kg/m2; P>.99). The differences in BMI increase across racial groups were significant (P=.03) in those with paraplegia (American Spinal Injury Association Impairment Scale A, B or C), those who were underweight or of normal weight at baseline, and those within 10 years of their injury. Such racial differences remained significant after taking into account demographic and injury characteristics. CONCLUSIONS Our study findings provide a foundation for future research to explore risk and protective factors that contribute to racial differences in weight gain after SCI, which help alert health care professionals to a high-risk group for obesity prevention and management.
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Affiliation(s)
- Huacong Wen
- Department of Physical Therapy, School of Health Professionals, University of Alabama at Birmingham, Birmingham, AL; Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
| | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL.
| | - Yin He
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - C Scott Bickel
- Department of Physical Therapy, School of Health Professions, Samford University, Birmingham, AL
| | - Susan Robinson-Whelen
- Spinal Cord Injury and Disability Research Center, TIRR Memorial Hermann, Houston, TX; Department of Physical Medicine and Rehabilitation, Center for Research on Women with Disabilities, Baylor College of Medicine, Houston, TX
| | - Allen W Heinemann
- Shirley Ryan Ability Lab, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Energy expenditure in people with motor-complete paraplegia. Spinal Cord 2017; 55:774-781. [DOI: 10.1038/sc.2017.27] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 01/27/2017] [Accepted: 02/09/2017] [Indexed: 11/08/2022]
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Scandola M, Aglioti SM, Avesani R, Bertagnoni G, Marangoni A, Moro V. Corporeal illusions in chronic spinal cord injuries. Conscious Cogn 2017; 49:278-290. [DOI: 10.1016/j.concog.2017.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/01/2016] [Accepted: 01/13/2017] [Indexed: 12/13/2022]
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