SCI: Caloric and Protein Needs in Acute and Rehabilitation Phases (2007)


Houda B. Evaluation of Nutritional Status in Persons with Spinal Cord Injury: A Prerequisite for Successful Rehabilitation. SCI Nursing 1993;10(7):4-7.

PubMed ID: 8484107
Study Design:
Narrative Review
R - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:
  • Describe nutritional assessment in spinal cord injured patients as a prerequisite for successful rehabilitation.
Inclusion Criteria:
  • Article inclusion criteria not described.
Exclusion Criteria:
  • None mentioned.
Description of Study Protocol:

Recruitment:  article selection methods not described

Design:  Narrative Review

Blinding Used (if applicable):  not applicable

Intervention (if applicable):  not applicable

Statistical Analysis:  not performed

Data Collection Summary:

Timing of Measurements:  not applicable

Dependent Variables:  not applicable

Independent Variables:  not applicable

Control Variables:  not applicable

Description of Actual Data Sample:

Initial N:  13 references cited.

Attrition (final N):  13

Age:  not mentioned

Ethnicity:  not mentioned

Other relevant demographics:


Location:  Worldwide studies

Summary of Results:

Alternatives for estimating energy expenditure and needs:

  • Harris-Benedict equation
    x1.2 for inactive bed patients
    x1.3 if out of bed.

In case of stress or infection, an additional injury factor may have to be added to the BEE and activity factor.

It is recommended that 500 calories be added to the basal energy needs, activity factor, and stress factor to obtain a one pound weight gain per week when weight gain is necessary.

  • Indirect calorimetry recommended as more accurate.
  • Quadriplegics and paraplegics consume energy at different rates; 22.7 and 27.9 kcal/kg of ideal body weight, respectively, are recommended to maintain their body weight. [Reviewer’s note: Cox’s original work used “current body weight” not ideal.]

Protein: 0.8 gm/kg body weight for maintenance of non-compromised patient, up to 1.5 gm/kg for pressure ulcers or infection.

Nitrogen-calorie ratio of 1:150 to prevent oxidation of amino acids for energy needs. 1:100 may be necessary in multiple infections, severe pressure ulcers, and negative nitrogen balance.

Also addressed:

  • Weight
  • Fluid requirement
  • Nutrition education
  • Dietitian as part of team with social worker coordinator of program, nursing coordinator, registered nurses, licensed practical nurse, home-health technician, social worker, doctor, dietitian and secretary, and patient.
Author Conclusion:

The dietitian, as a member of the health care team, has responsibility for the nutritional care of SCI individuals, both in the hospital and outpatient setting.  Education to achieve and maintain a normal nutritional status can enable the patient to develop the strength, energy and mental ability to lead a productive life. 

Funding Source:
University/Hospital: Edward Hines Jr. VA Hospital
Reviewer Comments:
  • ”Traditional” review article with no description of search, selection, or critique of articles.
  • Specifics are referenced and alternatives presented, but without critical appraisal.
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? No
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes