Feasibility and Acceptability of Implementing Indirect Calorimetry Into Routine Clinical Care of Patients With Spinal Cord Injury

Top Spinal Cord Inj Rehabil, 2016 · DOI: 10.1310/sci2016-00001 · Published: October 1, 2016

Spinal Cord Injury Nutrition & Dietetics Rehabilitation

Simple Explanation

Spinal cord injury (SCI) leads to changes in body composition, including muscle atrophy and increased fat mass. Predictive equations for energy requirements are not valid for SCI patients. Achieving accurate energy balance is important for SCI individuals, as inadequate nutrition can lead to malnutrition, while excessive caloric intake can lead to obesity. Indirect calorimetry (IC) is the gold standard for assessing resting energy expenditure (REE) in SCI patients, but its use is mainly in research settings. This study assesses the feasibility of implementing IC into routine clinical care.

Study Duration

4 months

Participants

25 SCI patients

Evidence Level

Not specified

Key Findings

1
IC is feasible and acceptable for routine clinical care of SCI patients undergoing rehabilitation.
2
Patients showed a willingness to repeat IC, and staff agreed it was acceptable to integrate IC into usual care.
3
Valid steady-state REE data can be obtained from SCI patients at the bedside without changes to standard protocols.

Research Summary

This study assessed the feasibility and acceptability of incorporating indirect calorimetry (IC) into the routine clinical care of patients with spinal cord injury (SCI) undergoing rehabilitation. The study found that patient adherence to protocol-driven measurement of resting energy expenditure (REE) using IC was high, and reliable REE data were obtained. Both patients and staff found the IC procedure acceptable, suggesting that it is not a barrier to routine implementation in the SCI rehabilitation setting. This could improve nutrition-related outcomes for this population.

Practical Implications

Improved Nutrition Assessment

IC provides a valuable addition to nutrition assessment and intervention by providing accurate measures of energy needs.

Reduced Risk of Malnutrition/Obesity

Accurate energy prescription reduces the likelihood of under- or overfeeding and associated sequelae during rehabilitation.

Optimized Caloric Prescription

Repeated use of IC across rehabilitation and the lifespan may facilitate optimal caloric prescription and minimize adverse health outcomes.

Study Limitations

1
The study was confined to the rehabilitation setting, limiting generalizability to acute and outpatient settings.
2
The cost and time required for IC use were not explored, which may be barriers to routine implementation.
3
Further validation of appropriate injury and activity factors for clinical use of REE data is needed.

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