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

STUDY

DESIGN

Prospective mixed methods implementation study.

OBJECTIVES

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.

SETTING

Victorian Spinal Cord Service, Australia

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.