Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Monitoring outcome measures for cardiometabolic disease during rehabilitation and follow-up in people with spinal cord injury

Spinal Cord volume 62, pages 125–132 (2024)Cite this article

Subjects

Abstract

Study design

Controlled pragmatic intervention with follow-up.

Objectives

To describe cardiometabolic risk outcomes after a pragmatic intervention implemented into standard spinal cord injury (SCI) rehabilitation.

Setting

Inpatient SCI rehabilitation in East-Denmark.

Participants

Inpatients, >18 years, having sustained a SCI within the last 12 months at admission to rehabilitation, regardless of etiology, neurological level or completeness of the lesion or mobility status.

Methods

Patient education on health promotion was guided by evidence and included feedback on peak oxygen uptake (VO2peak) (primary outcome measure), body mass index (BMI), Dual energy X-ray absorptiometry and metabolic profile (secondary outcome measures). Paired t-tests, non-parametric tests and Analysis of Variance (ANOVA) were used for analyzes. VO2peak and BMI were compared to historical data.

Results

VO2peak increased significantly from admission to discharge but did not exceed historical data despite a minimal clinical important difference. BMI decreased significantly during rehabilitation (p < 0.001) followed by a significant increase after discharge (p = 0.006). There was a trend that people with American Spinal Injury Association Impairment Scale (AIS) D SCI increased lean mass to nearly normal values. Criteria for pre-diabetes or diabetes were present in 28.5% and dyslipidemia in 45% of the participants 44.2 days after time of injury.

Conclusions

Despite improvements during rehabilitation, outcome measures were worse than recommended, and most outcome measures worsened at follow up, even in people with an AIS D SCI. Meaningful support regarding exercise and diet when tackling altered life circumstances is needed after discharge.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flow diagram showing the number of participants having performed objective outcome measures used in the Study III at admission (TI), discharge (TII) and follow-up (TIII).
Fig. 2

Similar content being viewed by others

Data availability

The datasets generated and analyzed in the current study are available upon reasonable request to the corresponding author.

References

  1. Farkas GJ, Gater DR. Neurogenic obesity and systemic inflammation following spinal cord injury: A review. J Spinal Cord Med. 2018;41:378–87.

    Article  PubMed  Google Scholar 

  2. van der Scheer JW, Martin Ginis KA, Ditor DS, Goosey-Tolfrey VL, Hicks AL, West CR, et al. Effects of exercise on fitness and health of adults with spinal cord injury: A systematic review. Neurology. 2017;89:736–45.

    Article  PubMed  Google Scholar 

  3. Nash MS, Groah SL, Gater DR Jr, Dyson-Hudson TA, Lieberman JA, Myers J, et al. Identification and Management of Cardiometabolic Risk after Spinal Cord Injury: Clinical Practice Guideline for Health Care Providers. Top Spinal Cord Inj Rehabilit. 2018;24:379–423.

    Article  Google Scholar 

  4. Martin Ginis KA, Jörgensen S, Stapleton J. Exercise and sport for persons with spinal cord injury. PMR J Inj Funct Rehabilit. 2012;4:894–900.

    Article  Google Scholar 

  5. Martin Ginis KA, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, et al. Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord. 2018;56:308–21.

    Article  PubMed  Google Scholar 

  6. Nooijen CF, Stam HJ, Bergen MP, Bongers-Janssen HM, Valent L, van Langeveld S, et al. A behavioural intervention increases physical activity in people with subacute spinal cord injury: a randomised trial. J Physiother. 2016;62:35–41.

    Article  PubMed  Google Scholar 

  7. Felleiter P, Krebs J, Haeberli Y, Schmid W, Tesini S, Perret C. Post-traumatic changes in energy expenditure and body composition in patients with acute spinal cord injury. J Rehabilit Med. 2017;49:579–84.

    Article  Google Scholar 

  8. Burkhart L, Pellegrini CA, Jones K, LaVela SL. Strategies used by providers to support individuals with spinal cord injury in weight management: a qualitative study of provider perspectives. Spinal Cord Ser Cases. 2021;7:65.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34:535–46.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Halvorsen A, Pettersen AL. NordicSCIR Årsrapport 2019. 2019. Available from. https://stolav.no/Medisinskekvalitetsregistre/NorSCIR/%C3%85rsrapporter/NORSCIR%20%C3%A5rsrapport%202019.pdf.

  11. Holm NJ, Møller T, Adamsen L, Dalsgaard LT, Biering-Sorensen F, Schou LH. Health promotion and cardiovascular risk reduction in people with spinal cord injury: physical activity, healthy diet and maintenance after discharge- protocol for a prospective national cohort study and a preintervention- postintervention study. BMJ Open. 2019;9:e030310.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Holm NJ, Biering-Sørensen F, Schou LH, Møller T. The test-retest reliability of individualized VO(2)peak test modalities in people with spinal cord injury undergoing rehabilitation. Spinal Cord. 2021;59:82–91.

    Article  PubMed  Google Scholar 

  13. Holm NJ, Steensgaard R, Schou LH, Møller T, Kasch H, Biering-Sørensen F. An observational study on body mass index during rehabilitation and follow-up in people with spinal cord injury in Denmark. Spinal Cord. 2022;60:157–62. https://doi.org/10.1038/s41393-021-00730-5.

    Article  PubMed  Google Scholar 

  14. Bauman WA, Biering-Sørensen F, Krassioukov A. The international spinal cord injury endocrine and metabolic function basic data set. Spinal Cord. 2011;49:1068–72.

    Article  CAS  PubMed  Google Scholar 

  15. Larsen CM, Juul-Kristensen B, Kasch H, Hartvigsen J, Frich LH, Boyle E, et al. The Danish Spinal Cord Injury Shoulder (DanSCIS) cohort: methodology and primary results. Spinal Cord. 2021;59:821–31.

    Article  PubMed  Google Scholar 

  16. Biering-Sørensen F, DeVivo MJ, Charlifue S, Chen Y, New PW, Noonan V, et al. International Spinal Cord Injury Core Data Set (version 2.0)-including standardization of reporting. Spinal Cord. 2017;55:759–64.

    Article  PubMed  Google Scholar 

  17. Suetta C, Haddock B, Alcazar J, Noerst T, Hansen OM, Ludvig H, et al. The Copenhagen Sarcopenia Study: lean mass, strength, power, and physical function in a Danish cohort aged 20-93 years. J Cachexia Sarcopenia Muscle. 2019;10:1316–29.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wu X, Liu J, Tanadini LG, Lammertse DP, Blight AR, Kramer JL, et al. Challenges for defining minimal clinically important difference (MCID) after spinal cord injury. Spinal Cord. 2015;53:84–91.

    Article  CAS  PubMed  Google Scholar 

  19. Laughton GE, Buchholz AC, Martin Ginis KA, Goy RE. Lowering body mass index cutoffs better identifies obese persons with spinal cord injury. Spinal Cord. 2009;47:757–62.

    Article  CAS  PubMed  Google Scholar 

  20. Eriks-Hoogland I, Hilfiker R, Baumberger M, Balk S, Stucki G, Perret C. Clinical assessment of obesity in persons with spinal cord injury: validity of waist circumference, body mass index, and anthropometric index. J Spinal Cord Med. 2011;34:416–22.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Bjerre E, Brasso K, Midtgaard J. Pragmatic trials are important to medical research. Ugeskr Laege. 2015;177:V10140571.

    Google Scholar 

  22. Aspenes ST, Nilsen TI, Skaug EA, Bertheussen GF, Ellingsen Ø, Vatten L, et al. Peak oxygen uptake and cardiovascular risk factors in 4631 healthy women and men. Med Sci Sports Exerc. 2011;43:1465–73.

    Article  PubMed  Google Scholar 

  23. Simmons OL, Kressler J, Nash MS. Reference fitness values in the untrained spinal cord injury population. Arch Phys Med Rehabilit. 2014;95:2272–8.

    Article  Google Scholar 

  24. Nooijen CF, Stam HJ, Sluis T, Valent L, Twisk J, van den Berg-Emons RJ. A behavioral intervention promoting physical activity in people with subacute spinal cord injury: secondary effects on health, social participation and quality of life. Clin Rehabilit. 2017;31:772–80.

    Article  Google Scholar 

  25. de Groot S, Dallmeijer AJ, Post MW, Angenot EL, van den Berg-Emons RJ, van der Woude LH. Prospective analysis of lipid profiles in persons with a spinal cord injury during and 1 year after inpatient rehabilitation. Arch Phys Med Rehabilit. 2008;89:531–7.

    Article  Google Scholar 

  26. Solinsky R, Betancourt L, Schmidt-Read M, Kupfer M, Owens M, Schwab JM, et al. Acute Spinal Cord Injury Is Associated With Prevalent Cardiometabolic Risk Factors. Arch Phys Med Rehabilit. 2022;103:696–701. https://doi.org/10.1016/j.apmr.2021.04.022.

    Article  Google Scholar 

  27. Sundhedsstyrelsen. Danskernes sundhed- Den nationale sundhedsprofil 2017. 2018. Available from: https://www.sst.dk/-/media/Udgivelser/2018/Den-Nationale-Sundhedsprofil-2017.ashx?la=da&hash=421C482AEDC718D3B4846FC5E2B0EED2725AF517.

  28. Lawrason SVC, Todd KR, Shaw RB, Martin Ginis KA. Physical activity among individuals with spinal cord injury who ambulate: a systematic scoping review. Spinal Cord. 2020;58:735–45.

    Article  PubMed  Google Scholar 

  29. Ma Y, de Groot S, Romviel S, Achterberg W, van Orsouw L, Janssen TWJ. Changes in body composition during and after inpatient rehabilitation in people with recent spinal cord injury. Spinal Cord Ser Cases. 2021;7:88.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Weber L, Voldsgaard NH, Holm NJ, Schou LH, Biering-Sørensen F, Møller T. Exploring the contextual transition from spinal cord injury rehabilitation to the home environment: a qualitative study. Spinal Cord. 2021;59:336–46.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors thank all participants and health care professionals across multidisciplinary disciplines for contributing to the study, thus reflecting the clinical setting and standard care.

Funding

This work was supported by a research program, “Centre for Integrated Rehabilitation of Cancer Patients (CIRE) - Neuro/Psychology”, conducted collaboratively by the University Hospitals Centre for Health Care Research, University Hospital Copenhagen, Rigshospitalet, University College Copenhagen, Department of Nursing and Nutrition, and the NeuroScience Centre, Rigshospitalet.

Author information

Authors and Affiliations

  1. Rigshospitalet, Neuroscience Center, Department for Spinal Cord and Brain Injuries, Hornbæk, Denmark

    Nicolaj J. Holm & Fin Biering-Sørensen

  2. University Hospitals Centre for Health Care Research, University hospital Copenhagen, Rigshospitalet, Denmark

    Tom Møller

  3. University College Copenhagen, Department of Nursing and Nutrition, Copenhagen, Denmark

    Lone H. Schou

  4. Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Fin Biering-Sørensen

Authors
  1. Nicolaj J. Holm
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tom Møller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lone H. Schou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fin Biering-Sørensen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NJH was primarily responsible for the study and collecting data as well as data analysis. FB-S facilitated implementation of DXA-scans and cardiometabolic profile. Together with TM and LS all authors contributed to the study design, text writing, manuscript feedback and approved the final version of the manuscript.

Corresponding author

Correspondence to Nicolaj J. Holm.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research. The project is approved by the Committees on Health Research Ethics in the Capital Region of Denmark on 10.07.2018 (Journal-nr.: H-18018325). All participants received oral, as well as written information about the study, before verbal and written consent was obtained. The project is registered at Clinicaltrials.gov (NCT03689023).

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Holm, N.J., Møller, T., Schou, L.H. et al. Monitoring outcome measures for cardiometabolic disease during rehabilitation and follow-up in people with spinal cord injury. Spinal Cord 62, 125–132 (2024). https://doi.org/10.1038/s41393-023-00956-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41393-023-00956-5

Search

Advanced search

Quick links