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Health promotion and cardiovascular risk reduction in people with spinal cord injury: physical activity, healthy diet and maintenance after discharge- protocol for a prospective national cohort study and a preintervention- postintervention study.

BMJ open
December 31, 2019
Nicolaj Jersild Holm et al. (6 authors)
Journal ArticleResearch Support, Non-U.S. Gov'tHuman Study
Study Details

Study Goal

The researchers aimed to evaluate the implementation of a multimodal patient education intervention, including a healthy diet, to manage cardiometabolic risk in individuals with spinal cord injury (SCI) during subacute rehabilitation.

Results Summary

The study assessed the impact of a standardized education approach on cardiovascular risk factors, physical activity, and healthy diet, with outcomes measured at admission, discharge, and 6 months post-discharge. Results included changes in BMI, metabolic profile, and dietary habits, though specific dietary outcomes were not detailed in the abstract.

Population

Adults aged 18+ with SCI within the past 12 months admitted to specialized rehabilitation.

Effective Dosage

Not specified

Duration

Intervention began at rehabilitation outset, with follow-up at discharge and 6 months post-discharge.

Interactions

None mentioned

Extracted Claims (14)
InterventionDirectionEndpointPopulationDosageImpactClaim #
multimodal patient education
neutral
identification and management of cardiometabolic risk after SCI
patients with SCI within the previous 12 months admitted to highly specialised rehabilitation
-
investigate implementation of recommendations
#1
standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet
neutral
peak oxygen uptake (VO2peak)
patients with SCI within the previous 12 months admitted to highly specialised rehabilitation
-
evaluates the effect
#2
standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet
neutral
BMI
patients with SCI within the previous 12 months admitted to highly specialised rehabilitation
-
evaluates the effect
#3
standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet
neutral
body composition
patients with SCI within the previous 12 months admitted to highly specialised rehabilitation
-
evaluates the effect
#4
standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet
neutral
metabolic profile
patients with SCI within the previous 12 months admitted to highly specialised rehabilitation
-
evaluates the effect
#5
standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet
neutral
neurological status
patients with SCI within the previous 12 months admitted to highly specialised rehabilitation
-
evaluates the effect
#6
standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet
neutral
level of functioning
patients with SCI within the previous 12 months admitted to highly specialised rehabilitation
-
evaluates the effect
#7
standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet
neutral
depression
patients with SCI within the previous 12 months admitted to highly specialised rehabilitation
-
evaluates the effect
#8
standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet
neutral
quality of life
patients with SCI within the previous 12 months admitted to highly specialised rehabilitation
-
evaluates the effect
#9
standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet
neutral
objective PA (accelerometry)
patients with SCI within the previous 12 months admitted to highly specialised rehabilitation
-
evaluates the effect
#10
standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet
neutral
self-reported PA
patients with SCI within the previous 12 months admitted to highly specialised rehabilitation
-
evaluates the effect
#11
standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet
neutral
self-assessed PA ability
patients with SCI within the previous 12 months admitted to highly specialised rehabilitation
-
evaluates the effect
#12
standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet
neutral
shared decision making
patients with SCI within the previous 12 months admitted to highly specialised rehabilitation
-
evaluates the effect
#13
standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet
neutral
dietary habits
patients with SCI within the previous 12 months admitted to highly specialised rehabilitation
-
evaluates the effect
#14
Abstract

INTRODUCTION: Spinal cord injury (SCI) predisposes those who suffer from it to physical inactivity and weight gain; consequently, death due to cardiovascular diseases is more frequent among people with SCI than in the general population. The literature documents a consensus about an interdisciplinary multimodal approach for the prevention and treatment of cardiovascular risk factors including overweight and obesity in people with SCI, focusing on diet, physical activity (PA) and behavioural interventions. This study will investigate implementation of recommendations from a recent clinical practice guideline for identification and management of cardiometabolic risk after SCI through multimodal patient education in a subacute clinical setting. METHODS AND ANALYSIS: All patients who are aged 18 years or older with an SCI within the previous 12 months and admitted to highly specialised rehabilitation are included, regardless of SCI aetiology or neurological level. A primary study designed as a controlled, pragmatic, preintervention- postintervention study with 6-month follow-up evaluates the effect of the clinical intervention; a prospective national cohort study on body mass index (BMI) serves as a historical control. The intervention consists of a standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet that begins at the outset of primary SCI rehabilitation and is integrated into existing settings and workflows. Outcome measures are collected at admission, discharge and 6 months after discharge and include peak oxygen uptake (VO2peak) (primary outcome), BMI, body composition, metabolic profile, neurological status, level of functioning, depression, quality of life, objective PA (accelerometry), self-reported PA, self-assessed PA ability, shared decision making, and dietary habits. Test-retest reliability of four VO2peak test protocols are investigated, as is test-retest reliability of a multisensor accelerometer in a rehabilitation setting. ETHICS AND DISSEMINATION: The project is approved by the Committees on Health Research Ethics in the Capital Region of Denmark on 10 July 2018 (Journal-nr.: H-18018325). The principal investigator obtains informed consent from all participants. The interventions in the project are closely related to existing rehabilitation care, and the risk of pain and discomfort is considered modest. Any unintended events related to the elements of the intervention are reported, according to existing regional procedures. Data are stored in a secure web-based database (Redcap). The primary study and prospective cohort study are registered at Clinicaltrials.gov. Positive and negative results will be submitted to relevant scientific journals related to SCI for publication. Important protocol modifications are reported to the Committees on Health Research Ethics in the Capital Region of Denmark. TRIAL REGISTRATION NUMBERS: NCT03689023 and NCT03369080.

Medical Subject Headings (MeSH)
Cardiovascular DiseasesDiet, HealthyExerciseHealth Knowledge, Attitudes, PracticeHealth PromotionHumansObesityObservational Studies as TopicProspective StudiesQuality of LifeResearch DesignRisk FactorsRisk Reduction BehaviorSpinal Cord Injuries
Study Links
Quality Scores
SafetyNot Assessed
Efficacy75/10
Quality85/10
Citation Metrics
Total Citations9
Citations/Year1.5
Relative Citation Ratio1.07
NIH Percentile52.9%
Research Impact Scores
APT Score0.75
Weight Score2.23
Normalized Score0.67
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