Top Spinal Cord Inj Rehabil. 2014;20(4):329-37. doi: 10.1310/sci2004-329.
Health care provider practices, barriers, and facilitators for weight management for individuals with spinal cord injuries and disorders.
Topics in spinal cord injury rehabilitation
Sara M Locatelli, Ben S Gerber, Barry Goldstein, Frances M Weaver, Sherri L LaVela
Affiliations
Affiliations
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Department of Veterans Affairs (DVA) , Hines, Illinois ; Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, DVA , Hines, Illinois.
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Department of Veterans Affairs (DVA) , Hines, Illinois ; Institute for Health Research and Policy, University of Illinois at Chicago , Chicago, Illinois.
- Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, DVA , Hines, Illinois ; SCI Healthcare Group, VA Puget Sound Healthcare System , Seattle, Washington.
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Department of Veterans Affairs (DVA) , Hines, Illinois ; Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, DVA , Hines, Illinois ; Program in Health Services Research, Stritch School of Medicine, Loyola University , Maywood, Illinois.
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Department of Veterans Affairs (DVA) , Hines, Illinois ; Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, DVA , Hines, Illinois ; Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University , Chicago, Illinois.
PMID: 25477746
PMCID: PMC4252133 DOI: 10.1310/sci2004-329
Abstract
BACKGROUND: Even though weight management is essential for the health of individuals with spinal cord injuries and disorders (SCI/D), little is known about current practices, barriers, and facilitators.
OBJECTIVE: To describe weight management delivery in the Veterans Affairs (VA) SCI/D System of Care, including barriers and facilitators experienced by health care providers.
METHODS: Qualitative focus groups were conducted in person at 4 geographically dispersed VA medical facilities delivering care to Veterans with SCI/D. Thirty-two employees involved in weight management efforts participated. Audio-recordings were transcribed and analyzed using qualitative content analysis techniques.
RESULTS: Participants at SCI centers reported that weight management treatment was delivered through the center by a multidisciplinary team using education (eg, written materials) and counseling/consults. Participants at SCI spoke facilities generally depended on facility-level programs (eg, MOVE!) to deliver treatment. Spoke facilities discussed barriers to delivering treatment through their SCI team, including staff shortages and resource and structural issues. MOVE! staff discussed barriers, including limited wheelchair space in classrooms. Staff participants across facilities noted that Veterans with SCI/D were hesitant to use facility-level programs, because of nonspecific SCI-relevant information and discomfort attending sessions with general Veterans. Other barriers, for both centers and spoke facilities, included necessary medications that increase weight, lack of evidence-based guidelines for weight management, safety concerns, and facility layout/accessibility. Facilitators included facility leadership support, provider involvement/prioritization, and community resources.
CONCLUSIONS: Weight management programs delivered through the SCI team, with peers and SCI-relevant content, are likely more acceptable and beneficial to individuals with SCI/D. Program classrooms should provide ample space for individuals with SCI/D.
Keywords: United States Department of Veterans Affairs; Veterans; obesity; overweight; weight reduction programs
References
- Disabil Rehabil. 2010;32(9):741-54 - PubMed
- Arch Phys Med Rehabil. 2011 Mar;92(3):384-90 - PubMed
- Prev Chronic Dis. 2009 Jul;6(3):A98 - PubMed
- Circulation. 2011 Sep 6;124(10):1182-203 - PubMed
- J Spinal Cord Med. 2011;34(2):227-32 - PubMed
- J Manipulative Physiol Ther. 2010 Jul-Aug;33(6):413-8 - PubMed
- J Rehabil Med. 2010 Nov;42(10):922-8 - PubMed
- Spinal Cord. 2009 Oct;47(10):757-62 - PubMed
- Implement Sci. 2009 Aug 07;4:50 - PubMed
- Circulation. 2010 Jul 27;122(4):406-41 - PubMed
- Implement Sci. 2013 Mar 09;8:28 - PubMed
- Psychiatr Clin North Am. 2011 Dec;34(4):861-9 - PubMed
- J Cardiopulm Rehabil Prev. 2011 Mar-Apr;31(2):73-80 - PubMed
- PM R. 2012 Nov;4(11):894-900 - PubMed
- Am Psychol. 2000 Feb;55(2):205-17 - PubMed
- Spinal Cord. 2006 Feb;44(2):82-91 - PubMed
- J Pain. 2008 Jul;9(7):606-12 - PubMed
- Eat Weight Disord. 2012 Mar;17(1):e9-16 - PubMed
- Am J Phys Med Rehabil. 2010 Mar;89(3):249-63 - PubMed
- Spinal Cord. 2011 Feb;49(2):266-72 - PubMed
- Prev Chronic Dis. 2012;9:E129 - PubMed
- Obes Rev. 2011 Jun;12(6):459-69 - PubMed
- Sports Med. 2010 Aug 1;40(8):681-96 - PubMed
- Am J Prev Med. 2011 Nov;41(5):457-64 - PubMed
- Int J Obes (Lond). 2013 Jan;37(1):118-28 - PubMed
- J Spinal Cord Med. 2011 Nov;34(6):586-93 - PubMed
- Prev Chronic Dis. 2012;9:E16 - PubMed
- Spinal Cord. 2013 Jan;51(1):27-32 - PubMed
- Spinal Cord. 2011 Nov;49(11):1103-27 - PubMed
- Am J Phys Med Rehabil. 2010 May;89(5):353-61 - PubMed
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