Patients' perspective on the comprehensive preventive health evaluation in veterans with spinal cord injury

Background: Diagnosing and managing obesity in individuals with spinal cord injury (SCI) remain challenging. Methods: Literature on the epidemiology, impact, and management of obesity in individuals with SCI was reviewed. Findings: Although nearly 66% of individuals with SCI are either overweight or obese, little guidance is available to measure and monitor obesity in the clinical setting. The use of anthropometric indices and specific cut points available for able-bodied persons is limited by the body composition changes that follow SCI. Indices of upper body obesity warrant examination in SCI because they provide an index of central obesity, which is more closely linked to some obesity-related conditions than is overall obesity. Investigations into the sequelae of excess body fat and its distribution are also needed in SCI because past research in this area has been inconclusive. Although limited, evidence regarding obesity interventions in SCI may be promising. Conclusions:The best anthropometric tool to define obesity in the clinical setting remains unknown. SCIspecific assessment tools and a better understanding of the sequelae of excess body weight will lead to better targeting of prevention and treatment efforts. More research is needed on the individual components of a weight management program unique to SCI. Until then, providers are urged to use a team approach and draw on existing resources and applicable research in able-bodied individuals to facilitate weight management in individuals with SCI.

Section: Management Treatmentmentioning

confidence: 99%

Clinical Assessment and Management of Obesity in Individuals With Spinal Cord Injury: A Review

Rajan

McNeely

Warms

et al. 2008

“…8,9 This is especially disappointing since physician recommendation has been shown to be highly associated with compliance 5 and since 2000, CRC screening has been a VA performance measure for both the general veteran population, as well part of the VA SCI Annual Comprehensive Preventive Health Evaluation. 16 The importance of screening this population is heightened since sensory deficits and chronic rectal bleeding, either from hemorrhoids or regular digital fecal extraction, may mask symptoms or obviate the use of fecal occult blood tests (FOBTs). 17 As the life expectancy of this population now approximates that of the general veteran population, 18 regular CRC screening represents a critical opportunity to save lives and improve quality of care.…”

Section: Introductionmentioning

confidence: 99%

Colonoscopy is high yield in spinal cord injury

Hayman

Guihan

Fisher

et al. 2013

Objectives/background: Colorectal cancer (CRC) can be prevented by routine colonoscopy. CRC screening in special populations, e.g. spinal cord injury and disorders, presents unique barriers and, potentially, a higher risk of complications. We were concerned about potentially higher risks of complications and sought to determine the safety of colonoscopy. Methods: Retrospective observational design using medical record review for 311 patients who underwent 368 colonoscopies from two large VA SCI centers from 1997-2008. Patient demographics and peri-procedural characteristics, including indication, bowel prep quality, and pathological findings are presented. Descriptive statistics are presented. Results: The population was predominantly male and Caucasian, and 199 (64%) had high-level injuries (T6 or above). Median age at colonoscopy was 61 years (interquartile range 53-69). Just <1/2 of the colonoscopies were diagnostic, usually for evidence of rectal bleeding. Although a majority of colonoscopies were reported as poorly prepped, the proportion that were adequately prepped increased over time (from 3.7 to 61.3%, P = <0.0001). Of the 146 polyps removed, 101 (69%) were adenomas or carcinomas. Ten subjects had 11 complications, none of which required surgical intervention. Conclusions: Although providing quality colonoscopic care in this population is labor intensive, the data suggests that it appears safe and therapeutically beneficial. The results indicate that the risk of screening is outweighed by the likelihood of finding polyps. Recognition of the benefit of colonoscopy in this population may have improved bowel prep and reporting over time. Spinal cord injury providers should continue to offer screening or diagnostic colonoscopy to their patients when indicated, while being aware of the special challenges that they face.

“…inpatient vs. outpatient) also depends on a variety of factors, including acuity and Veteran preference. 22 Veterans living at a significant distance from an SCI center are generally admitted to the hospital or receive assistance with lodging during the annual evaluation, depending on their needs.…”

Section: Introductionmentioning

confidence: 99%

“…21 However, VHA does provide preventive care to Veterans with SCI via an annual Comprehensive Preventive Health Evaluation (or annual evaluation). 22 The evidence supporting the annual evaluation elements, including those that address PrU prevention, are primarily based on expert consensus, with some notable exceptions (e.g. colorectal cancer screening).…”

Section: Introductionmentioning

confidence: 99%

Documentation of preventive care for pressure ulcers initiated during annual evaluations in SCI

Guihan

Murphy

Rogers

et al. 2016

Objective: Community-acquired pressure ulcers (PrUs) are a frequent cause of hospitalization of Veterans with spinal cord injury (SCI). The Veterans Health Administration (VHA) recommends that SCI annual evaluations include assessment of PrU risk factors, a thorough skin inspection and sharing of recommendations for PrU prevention strategies. We characterized consistency of preventive skin care during annual evaluations for Veterans with SCI as a first step in identifying strategies to more actively promote PrU prevention care in other healthcare encounters. Design/setting/participants: Retrospective cross-sectional observational design, including review of electronic medical records for 206 Veterans with SCI admitted to 2 VA SCI centers from January-December, 2011. Outcome measures: Proportion of applicable skin health elements documented (number of applicable elements/skin health elements documented). Results: Our sample was primarily white (78%) male (96.1%), and mean age = 61 years. 40% of participants' were hospitalized for PrU treatment, with a mean of 294 days (median = 345 days) from annual evaluation to the index admission. On average, Veterans received an average of 75.5% (IQR 68-86%) of applicable skin health elements. Documentation of applicable skin health elements was significantly higher during inpatient vs. outpatient annual evaluations (mean elements received = 80.3% and 64.3%, respectively, P > 0.001). No significant differences were observed in documentation of skin health elements by Veterans at high vs. low PrU risk. Conclusion: Additional PrU preventive care in the VHA outpatient setting may increase identification and detection of PrU risk factors and early PrU damage for Veterans with SCI in the community, allowing for earlier intervention.