Implementing body composition assessment into clinical practice in patients with acute spinal cord injury- a pilot feasibility study.

The majority of eligible acute SCI patients consented to participate in the ATSCI-Nut pathway study.

• Twenty-three patients were eligible for the study.
• 21 out of 23 eligible patients (91%) consented to data collection.
• The study was conducted at the Victorian Spinal Cord Service, Australia.
• This was a prospective mixed methods implementation study.

Adherence to the ATSCI-Nut pathway varied across assessment components and declined over time.

• Adherence to the initial assessment component was 86%.
• Adherence to the review component during weeks 2–8 was 71%.
• Adherence to the review component at greater than 8 weeks was 69%.
• Feasibility outcomes including reach, adoption, and intervention fidelity were collected from medical records.

Adherence to completing bioimpedance spectroscopy (BIS) measurements at specified time-points was incomplete, with fewer than half of participants having all measurements completed as scheduled.

• Adherence to completing BIS measurements at specified time-points was 69%.
• Only 43% of participants had all BIS measurements completed at specified time-points.
• BIS was the body composition assessment method used in the ATSCI-Nut pathway.

Two themes were common to both patients and clinicians regarding the ATSCI-Nut pathway.

• The first shared theme was 'physiological and body composition changes directing focus of rehabilitation.'
• The second shared theme was 'barriers and enablers to optimal care.'
• Acceptability and appropriateness were explored via patient semi-structured interviews and clinician focus groups.
• These themes were identified through qualitative analysis as part of the mixed methods design.

An additional theme unique to patient interviews was identified regarding the psychosocial impact of SCI.

• The patient-specific theme was 'impact of SCI on self-image and lifestyle.'
• This theme did not arise from clinician focus groups.
• The study explored patient experiences with the care pathway and the effect of providing body composition information on dietary choices.

The ATSCI-Nut pathway was found to be feasible and acceptable for delivering body composition assessment in acute SCI patients, though barriers to optimal care were identified.

• The pathway was assessed across five feasibility dimensions: reach, adoption, adherence, appropriateness, and acceptability.
• Despite mixed adherence overall, the pathway was characterized as 'a feasible and acceptable model to deliver body composition assessment.'
• The authors noted that 'barriers to optimal patient care and pathway adaptations need to be explored to improve adherence.'
• The study was described as a pilot feasibility study, indicating it was preliminary in scope.