Assessment of body composition in spinal cord injury: A scoping review

PLoS ONE, 2021 · DOI: https://doi.org/10.1371/journal.pone.0251142 · Published: May 7, 2021

Spinal Cord Injury Physiology Rehabilitation

Simple Explanation

This review studies the best ways to measure body fat and muscle in adults with spinal cord injuries (SCI). People with SCI often have changes in their body composition that can lead to other health problems. The review looks at different tools used to measure body composition, from simple methods like skinfold measurements to more complex tools like DXA scans. It identifies which tools have been shown to be reliable and accurate for people with SCI. The review found that DXA is the most reliable and accurate tool currently available, but it is also expensive and not easily accessible. The review suggests more research is needed on simpler, more affordable tools like waist circumference and skinfold measurements.

Study Duration

Not specified

Participants

1,011 males and 143 females

Evidence Level

Scoping Review

Key Findings

1
Whole-body DXA is the only tool supported by studies showing both acceptable test-retest reliability and convergent validity for assessing body composition in SCI.
2
Practitioners considered cost and accessibility of DXA major barriers in applied settings.
3
Survey participants preferred simple tools if they could be confident in their reliability and validity.

Research Summary

This scoping review mapped the evidence on measurement properties of body composition tools to assess whole-body and regional fat and fat-free mass in adults with SCI, and to identify research gaps in order to set future research priorities. A total of 42 eligible articles were identified (1,011 males and 143 females). The only tool supported by studies showing both acceptable test-retest reliability and convergent validity was whole-body dual-energy x-ray absorptiometry (DXA). This review suggests that future research should prioritize reliability and validity studies on: (1) DXA as a surrogate ‘gold standard’ tool to assess whole-body composition, regional fat and fat-free mass; and (2) skinfold thickness and waist circumference as practical low-cost tools to assess regional fat mass in persons with SCI, and (3) females to explore potential sex differences of body composition assessment tools.

Practical Implications

Standardized Protocols

Establish standardized SCI-specific protocols for body composition assessment via DXA, waist circumference, and skinfold thickness.

Reliability Over Time

Establish reliability over time and across assessors/manufacturers for DXA, waist circumference and skinfold thickness measures.

Criterion Validity of DXA

Establish criterion validity of DXA using a four-compartment model as the reference method.

Study Limitations

1
Limited number of studies on test-retest reliability, criterion validity or responsiveness of body composition tools in the SCI population.
2
Insufficient inclusion of females in the available literature (only 12% of the sample).
3
Heterogeneity of the samples included (e.g., injury characteristics).

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