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Nutrition management of spinal cord injured patients: an investigation of resources and interventions in UK spinal cord injuries centres

Wong, Samford Shun Hung (2019). Nutrition management of spinal cord injured patients: an investigation of resources and interventions in UK spinal cord injuries centres. (Unpublished Doctoral thesis, City, University of London)

Abstract

Introduction: Spinal cord injured (SCI) patients have complex physical and psychological needs. Malnutrition (including under- and over- nutrition) is common after SCI, and is associated with adverse clinical outcomes such as increased risk of infection. To date, limited information is available to guide clinicians to identify, prevent and manage nutrition related complications in SCI patients. This gap in evidence has promoted a series of research studies addressing the following research aims: (1) To review and understand the variations in nutritional management in SCI centres (2) To evaluate whether currently implemented nutrition interventions (e.g probiotics use in preventing antibiotic associated diarrhoea (AAD) and Clostridium difficile infection (CDI) are evidence based and to discuss the potential barriers to good nutritional care in SCI centres; (3) To evaluate three original studies (bariatric surgery case studies; the use of oral nutritional supplement (ONS) and vitamin and minerals (VMS) and; the use of Lactobacillus casei Shirota (LcS) in preventing AAD. A total of seven peer reviewed papers, utilising a range of mixed research methodologies (observational studies, case study, surveys, randomised-controlled trials and systematic review protocol) were undertaken to demonstrate the effectiveness of nutrition interventions in patients admitted to SCI centres with a critical commentary.

Results: (1) Although most SCI centres use validated nutrition screening tool, the resource allocation for nutritional care appeared to be relatively limited; (2) Definition for AAD, CDI, under- / over-nutrition risk and choice of probiotics in preventing AAD / CDI are varied across SCI centres. (3) Three studies attempted to demonstrate an improvement in SCI patient’s quality of care are reported. These include: (i) the use of nutritional supplements in SCI patients at malnutrition-risk (undernutrition risk, serum albumin and haemoglobin level are predictors of oral nutrition supplements use); (ii) the first UK bariatric surgery in a morbidly obese SCI patient who failed all non-surgical interventions (an improvement in functional, anthropometrical and nutritional biochemistry was found after surgery) and (iii) the use of probiotics in preventing antibiotic associated diarrhoea (AAD). (Lactobacillus casei Shirota was found to prevent AAD when compared to a control, 17.1% v 54.9%, p<0.01).

Conclusion: Our studies suggest that resources allocated in SCI centres varied. Without sufficient nutritional resources in SCI centres, malnutrition will be under-detected and under treated. In addition, carefully planned nutrition / dietetic interventions could improve outcomes in SCI patients if nutritional care is embedded in the SCI care-pathway. Development of clinical nutrition practice guidelines are warranted, and further well-designed randomised controlled trails are required to confirm whether the effect of nutrition (and probiotic) intervention is cost- and clinically-effective.

Publication Type: Thesis (Doctoral)
Subjects: R Medicine > RT Nursing
Departments: Doctoral Theses
School of Health Sciences
URI: http://openaccess.city.ac.uk/id/eprint/22541
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