Development of Cardiometabolic Health indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

The Journal of Spinal Cord Medicine, 2019 · DOI: 10.1080/10790268.2019.1613322 · Published: January 1, 2019

Spinal Cord Injury Cardiovascular Science Rehabilitation

Simple Explanation

Spinal cord injury can lead to decreased physical activity and dyslipidemia, which increases the risk of cardiometabolic disease. This paper describes the selection of indicators for adults within the first 18 months post-SCI/D rehabilitation admission. A working group was formed to develop a definition of cardiometabolic risk factors. The group focused on prevention strategies. The study developed indicators related to the presence of resources for exercise prescription, lipid profile assessment, documented exercise prescriptions, patient knowledge, exercise adherence, and lipid status.

Study Duration

18 months

Participants

31 individuals with SCI/D

Evidence Level

Not specified

Key Findings

1
The structure indicator identifies the presence of appropriate time and resources for physical exercise prescription during rehabilitation.
2
Process indicators include lipid profile assessment at rehabilitation admission and documented exercise prescriptions prior to discharge.
3
Outcome indicators track patient’s knowledge retention, exercise adherence, and lipid status 18 months after rehabilitation discharge.

Research Summary

This paper describes the processes involved in the selection, development and implementation of structure, process and outcome indicators related to the Cardiometabolic Health Domain from rehabilitation admission to 18 months thereafter. The structure, process and outcome indicators selected and developed by the SCI-High Cardiometabolic Health Working Group are intended to facilitate prevention of cardiometabolic disease through routine evaluation of lipid profiles and education of individuals with SCI/D to SCI/D-specific exercise guidelines. Successful implementation of the indicators will characterize the cardiometabolic health status of individuals with SCI/D during the first 18 months following rehabilitation admission.

Practical Implications

Enhanced Detection of Dyslipidemia

Routine national implementation of these indicators will enhance efforts to detect dyslipidemia.

Promotion of Endurance Exercise

The indicators will assure routine participation in endurance exercise.

Improved Cardiometabolic Health

These indicators align with international initiatives to improve cardiometabolic health through interventions targeting modifiable risk factors.

Study Limitations

1
Exclusion of individuals with motor complete lesions above C6 limits generalizability.
2
Self-reported physical activity may be problematic in the SCI population.
3
Complex questionnaire terminology may reduce completion rates in patients with reduced cognitive ability or English fluency.

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