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SCI: Role of the Registered Dietitian (2007)

Citation:

Murphy M. Traumatic spinal cord injury: an acute care rehabilitation perspective. Crit Care Nurs Q. 1999 Aug;22(2):51-9. Review.

PubMed ID: 10646443
 
Study Design:
Narrative review
Class:
R - Click here for explanation of classification scheme.
Quality Rating:
Negative NEGATIVE: See Quality Criteria Checklist below.
Research Purpose:

The purpose of this narrative review was to provide major areas of concern in multidisciplinary care and rehabilitation in patients with spinal cord injury.

Inclusion Criteria:

The article is written to address treatment of individuals with spinal cord injury.

Exclusion Criteria:

No article selection criteria were provided.

Description of Study Protocol:

No article selection criteria were provided.  The narrative review only provided a summary of findings on eight major topics:

  1. Pressure ulcer prevention
  2. Splinting
  3. Mobilization
  4. Nutrition
  5. Gastrointestinal function
  6. Genitourinary function
  7. Pulmonary function
  8. Transition to a rehabilitation center.
Data Collection Summary:

N/A

Description of Actual Data Sample:

N/A

Summary of Results:

Other Findings

 Pressure Ulcer Prevention

  • Care staff education is essential to multidisciplinary plan of care
  • Positioning in chair or bed and reduction in shear injuries critical
    • Shift positions hourly
    • Regularly inspect bony prominences
    • When out of bed, shift weight regularly from hip to hip or by lifting completely off the seat for 2 minutes every 15 minutes .

Splinting

  • Splints can decrease risk for pressure ulcers and can protect bone prominences

Mobilization

  • Early mobilization can reduce complications. These include getting patients out of bed, tilt tables and range of motion exercises.

Nutrition

  • Dietitians should prescribe caloric needs and specific nutrient needs.
  • Speech therapist should diagnose swallowing capacity and prescribe diet consistency
  • Appetite may be altered by medications, stress, fatigue requiring family and patient education on importance of dietary intakes.

Gastrointestinal

  • Constipation and bowel incontinence are not uncommon.
  • Staff should work to alleviate concern and embarrassment of the patient
  • A docusate sodium enema could be used, preferably in the evening.  Twenty minutes after, the patient should be assisted to use a bed pan or beside toilet.
    • A digital rectal exam should follow to assess effectiveness of bowel emptying

Genitourinary

  • A Foley catheter should be monitored, with urinary volume maintained at one half of the normal bladder capacity. 

Pulmonary

  • Airway saliency should be maintained
  • Communication and speech may be limited due to respiratory compromise

Transition to Rehabilitation Center

  • Discussions with the family and patient should occur soon after admission about inpatient rehabilitation care, with an assessment of readiness to comprehend.
  • Goals to interview:
    • Establish rapport and trust
    • Active listening
    • Answer questions
    • Address issues surrounding impact on injury, address patients feelings and identify coping mechanisms
  • Psychological counseling and support are necessary for recovery

 

 

Author Conclusion:

A multidisciplinary team should enact a plan to promote rehabilitation and prevent complications in SCI patients.  A plan for entering a rehabilitation center and consideration of psychosocial elements can improve outcomes and progress of patient.

Funding Source:
University/Hospital: Allegheny General Hospital
Reviewer Comments:

This review provides very little detail in any area, especially when considering the interdependency of each of the areas on the other, which was not addressed.  This manuscript was written to speak for the disciplines (including dietetics) instead of present a multidisciplinary voice.

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? ???
  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? No
  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? No
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? No
  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? N/A
  10. Was bias due to the review's funding or sponsorship unlikely? ???