SCI: Preventing Overweight (2007)
Citation:
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:
- To determine if total body electrical conductivity (TOBEC) is a reliable and valid technique for estimating body composition in SCI patients.
- To test if there is a significant difference in fat-free mass and body fat percentage between sedentary and physically active SCI subjects.
Inclusion Criteria:
- SCI patients with chronic C6-L2 spinal cord transections whose injuries occurred a minimum of three years prior to data collection.
Exclusion Criteria:
- Not stated.
Description of Study Protocol:
Recruitment
Not described
Design
Comparison, by level of activity (physically active or sedentary by questionnaire), of TOBEC and anthropometric measures in males with SCI at a single point in time
Blinding used (if applicable)
Not applicable
Intervention (if applicable)
None
Statistical Analysis
- Intraclass (alpha) reliability by repeated measure of ANOVA.
- Construct validity by univariate analysis of variance.
- Validity also by Pearson product-moment correlation (between TOBEC % body fat and sum of seven skinfolds)
Data Collection Summary:
Timing of Measurements
Once
Dependent Variables
- Body weight (electronic scale)
- Circumferences (plastic tape measure, 3/8" wide) - abdominal, calf, chest, hip, midparm, thigh, waist
- Skinfold thicknesses (Lange skinfold calipers) - abdominal, anterior thigh, biceps, chest, subscapular, suprailiac, triceps
- Supine length (top of head to end of heel, with pillow under knees)
- TOBEC (2nd generation adult instrument chamber)
Independent Variables
- physical activity level
- SCI
Control Variables
none
Description of Actual Data Sample:
Initial N: 17 male SCI patients (12 active, 5 sedentary)
Attrition (final N): 17
Age: 23-43 years (mean 32.4)
Ethnicity: not mentioned.
Other relevant demographics: none mentioned
Anthropometrics: (see results)
Location: Baylor College of Medicine GCRC, Houston, TX
Summary of Results:
- The correlation between fat percentage measured by TOBEC and the sum of seven skinfolds was positive and significant (R=0.73, P<0.01). (e.g.: as skinfold thickness increased, so did % fat measured by TOBEC)
- There was no significant difference between active and sedentary groups in supine length, weight, supine weight-to-height ratios., circumferences, or skinfolds
- Significant differences were found between groups when comparing body fat percentage and total fat mass measures.
Variables | Active | Sedentary | Significance |
fat (%) | 15.6±4.8 | 23.3±4.7 | p<0.05 |
fat mass (kg) | 11.2±4.8 | 16.8±4.0 | p<0.05 |
fat free mass (%) | 84.4±4.8 | 76.7±4.7 | p<0.05 |
fat free mass (kg)
|
59.3±8.5
|
55.4± 4.4
|
NS |
Author Conclusion:
- The TOBEC was found to be an extremely reliable instrument for estimating fat percentage in SCI men.
- High reliability estimates for single and multiple trials indicate the use of a single trial will provide reliable body fat estimates.
- Average fat percentage and fat mass were significantly higher in sedentary compared to active subjects.
Funding Source:
Reviewer Comments:
- Small sample size. However, the high reliability coefficients and construct validity supports the use of TOBEC in SCI subjects.
- Small number of sedentary group. May not detect significances in certain measurements between active and sedentary groups.
- Statistic analysis was appropriate, meeting the purpose of the study design.
Quality Criteria Checklist: Primary Research
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Relevance Questions | |||
1. | Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) | Yes | |
2. | Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? | Yes | |
3. | Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? | Yes | |
4. | Is the intervention or procedure feasible? (NA for some epidemiological studies) | Yes | |
Validity Questions | |||
1. | Was the research question clearly stated? | Yes | |
1.1. | Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? | Yes | |
1.2. | Was (were) the outcome(s) [dependent variable(s)] clearly indicated? | Yes | |
1.3. | Were the target population and setting specified? | Yes | |
2. | Was the selection of study subjects/patients free from bias? | ??? | |
2.1. | Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? | ??? | |
2.2. | Were criteria applied equally to all study groups? | Yes | |
2.3. | Were health, demographics, and other characteristics of subjects described? | No | |
2.4. | Were the subjects/patients a representative sample of the relevant population? | ??? | |
3. | Were study groups comparable? | ??? | |
3.1. | Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) | Yes | |
3.2. | Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? | ??? | |
3.3. | Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) | ??? | |
3.4. | If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? | Yes | |
3.5. | If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) | ??? | |
3.6. | If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? | No | |
4. | Was method of handling withdrawals described? | N/A | |
4.1. | Were follow-up methods described and the same for all groups? | N/A | |
4.2. | Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) | N/A | |
4.3. | Were all enrolled subjects/patients (in the original sample) accounted for? | N/A | |
4.4. | Were reasons for withdrawals similar across groups? | N/A | |
4.5. | If diagnostic test, was decision to perform reference test not dependent on results of test under study? | N/A | |
5. | Was blinding used to prevent introduction of bias? | N/A | |
5.1. | In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? | N/A | |
5.2. | Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) | N/A | |
5.3. | In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? | N/A | |
5.4. | In case control study, was case definition explicit and case ascertainment not influenced by exposure status? | N/A | |
5.5. | In diagnostic study, were test results blinded to patient history and other test results? | N/A | |
6. | Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? | N/A | |
6.1. | In RCT or other intervention trial, were protocols described for all regimens studied? | N/A | |
6.2. | In observational study, were interventions, study settings, and clinicians/provider described? | N/A | |
6.3. | Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? | N/A | |
6.4. | Was the amount of exposure and, if relevant, subject/patient compliance measured? | N/A | |
6.5. | Were co-interventions (e.g., ancillary treatments, other therapies) described? | N/A | |
6.6. | Were extra or unplanned treatments described? | N/A | |
6.7. | Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? | N/A | |
6.8. | In diagnostic study, were details of test administration and replication sufficient? | N/A | |
7. | Were outcomes clearly defined and the measurements valid and reliable? | Yes | |
7.1. | Were primary and secondary endpoints described and relevant to the question? | Yes | |
7.2. | Were nutrition measures appropriate to question and outcomes of concern? | Yes | |
7.3. | Was the period of follow-up long enough for important outcome(s) to occur? | N/A | |
7.4. | Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? | Yes | |
7.5. | Was the measurement of effect at an appropriate level of precision? | Yes | |
7.6. | Were other factors accounted for (measured) that could affect outcomes? | ??? | |
7.7. | Were the measurements conducted consistently across groups? | Yes | |
8. | Was the statistical analysis appropriate for the study design and type of outcome indicators? | Yes | |
8.1. | Were statistical analyses adequately described and the results reported appropriately? | Yes | |
8.2. | Were correct statistical tests used and assumptions of test not violated? | Yes | |
8.3. | Were statistics reported with levels of significance and/or confidence intervals? | Yes | |
8.4. | Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? | N/A | |
8.5. | Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? | Yes | |
8.6. | Was clinical significance as well as statistical significance reported? | Yes | |
8.7. | If negative findings, was a power calculation reported to address type 2 error? | No | |
9. | Are conclusions supported by results with biases and limitations taken into consideration? | ??? | |
9.1. | Is there a discussion of findings? | Yes | |
9.2. | Are biases and study limitations identified and discussed? | No | |
10. | Is bias due to study's funding or sponsorship unlikely? | Yes | |
10.1. | Were sources of funding and investigators' affiliations described? | N/A | |
10.2. | Was the study free from apparent conflict of interest? | N/A | |