Implementing body composition assessment into clinical practice in patients with acute spinal cord injury- a pilot feasibility study

TL;DR

This study tests a new care pathway for assessing body composition in patients with spinal cord injuries, finding it feasible but needing improvements.

Contribution

A new care pathway (ATSCI-Nut) for body composition assessment in acute spinal cord injury patients was piloted and evaluated for feasibility.

Findings

The ATSCI-Nut pathway showed high patient consent rates and acceptable adherence to most components.

Bioimpedance spectroscopy measurements had mixed adherence, with only 43% of participants completing all measurements.

Patients and clinicians identified barriers and enablers to optimal care, and body composition changes influenced rehabilitation focus.

Abstract

Prospective mixed methods implementation study.

To: (1) implement a SCI-specific care pathway for body composition assessment (ATSCI-Nut); (2) pilot test the feasibility (reach, adoption, adherence, appropriateness, and acceptability) of the care pathway in patients with new traumatic SCI; (3) explore patient experiences with the care pathway and the effect of providing body composition information on dietary choices and (4) explore clinician experiences with the new care pathway.

Victorian Spinal Cord Service, Australia

Participants included individuals with acute SCI who received the ATSCI-Nut pathway and consented to data collection. Feasibility outcomes (reach, adoption and intervention fidelity) were collected from medical records. Acceptability and appropriateness were explored via patient semi-structured interviews and clinician focus groups.

Twenty-three patients were eligible, 21 (91%) consented. Adherence to the ATSCI-Nut pathway initial assessment and review components during weeks 2–8 and >8 weeks was 86, 71 and 69%, respectively. Adherence to completing bioimpedance spectroscopy (BIS) measurements at specified time-points was 69%. However, only 43% of participants had all BIS measurements completed at specified time-points. Two themes were common to patients and clinicians: physiological and body composition changes directing focus of rehabilitation, and barriers and enablers to optimal care. One additional theme arose from patient interviews: impact of SCI on self-image and lifestyle.

The ATSCI-Nut pathway is a feasible and acceptable model to deliver body composition assessment despite mixed adherence to the pathway overall. However, barriers to optimal patient care and pathway adaptations need to be explored to improve adherence.

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