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SCI: Preventing Overweight (2007)

Citation:

Claus-Walker J, Halstead LS. Metabolic and Endocrine Changes in Spinal Cord Injury: I. The Nervous System Before and After Transection of the Spinal Cord. Arch Phys Med Rehabil.  1981;62:595-601.

PubMed ID: 7316719
 
Study Design:
Meta-analysis or Systematic Review
Class:
R - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:

Comprehensive, concise review and analysis of the pertinent literature published over the last 25 years  (1956-1981) on the metabolic and endocrine consequences of spinal cord injury.

Inclusion Criteria:

Not described.

Exclusion Criteria:

Not described.

Description of Study Protocol:

Recruitment

Methods for study inclusion not described.  Articles selected from 1956 - 1981.

Design

Systematic Review.

Blinding Used (if applicable):

Not applicable.

Intervention (if applicable):

Not applicable.

Statistical Analysis

Statistical analysis not performed.

Data Collection Summary:

Timing of Measurements

Organized as:

  • Problems studied
  • Methods of investigation and results
  • Conclusions
  • Summary of results
  • Discrepancies areas of needed research practical clinical implications.

Dependent Variables

Pertinent data from original sources organized in tables for

  • Direct comparison between similar studies and
  • Between healthy and SCI subjects.

Independent Variables

Control Variables

Description of Actual Data Sample:

Initial N:  19 articles referenced.

Attrition (Final N):  19

Age:  not mentioned

Ethnicity:  not mentioned

Other relevant demographics:

Anthropometrics:

Location:  Worldwide studies

Summary of Results:

In quadriplegic subjects:

  • Progressive weight loss with increased proportion of body fat
  • Decreased urine creatinine per unit of body weight in early SCI 
  • Frequent hyperuricosuria without hyperuriosemia
  • Relatively high extra cellular fluid compartment
  • Negative fluid balance for the initial 3-4 weeks of paralysis
  • Relative depletion of exchangeable K+
  • Relative excess of exchangeable Na+
  • Low whole muscle mass blood flow, which increases during passive exercise.
Author Conclusion:
  • The atrophied muscle cell is eventually partially replaced with connective tissue and filled with lipid and water, which may explain why the patient's initial weight loss frequently reverses to weight gain.
  • Late SCI patients are frequently overweight and should be given a low caloric diet, but no amphetamines.
  • There is usually no need to look for a hormonal cause, and diuretics are generally not necessary.
Funding Source:
Government: Dept. of Health and Human Services
Reviewer Comments:
Systematic review and analysis of the metabolic and endocrine changes caused by neurologic alteration of the cervical cord literature at the time (1981). Areas for research and practical clinical applications given.
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? ???
  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? ???
 
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? ???
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? ???
  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? No
  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? No
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? No
  10. Was bias due to the review's funding or sponsorship unlikely? Yes