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RRP 09-224 – HSR&D Study

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RRP 09-224
Developing an implementation program for weight loss in persons with SCI
Suparna Rajan PhD MS
VA Puget Sound Health Care System Seattle Division, Seattle, WA
Seattle, WA
Funding Period: August 2009 - April 2011

BACKGROUND/RATIONALE:
To address the obesity problem among Veterans with spinal cord injuries and disorders (SCI/D), the Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI) is actively working to tailor and extend the VA's MOVE! weight management for Veterans program to this population. Individuals leading MOVE! group sessions may not be familiar with the unique needs and challenges of Veterans with SCI/D participating in the program.

OBJECTIVE(S):
The purpose of this project was to develop a manual with SCI/D specific information that will serve as a resource for MOVE! group leaders when there are participants with SCI/D.

METHODS:
A manual was developed and organized into seven sections. This first section was developed to provide MOVE! group leaders with an overview of SCI/D and information on topics relevant to weight management. The second section includes practical tips and suggestions for group leaders when working with this population. Sections 3-5 contain MOVE! group sessions, support group sessions and patient educational materials that were adapted to include disability-sensitive language and disability-inclusive activities. Section 6 contains a resource list of web sites, books, videos and national organizations that may provide helpful information for MOVE! group leaders in understanding exercise for individuals with SCI/D. Section 7 provides a reference list of research and review articles for in-depth information and rationale for the information provided in the previous sections of the manual. Feedback on a draft copy of the manual was solicited from an expert panel with expertise in spinal cord injury and rehabilitation medicine, diet and physical activity.

FINDINGS/RESULTS:
For each section, panel members provided feedback on the adequacy and clarity of information, suggestions for improvement and alternative information that might be included. Based on the feedback provided, section one was revised to include additional information on SCI/D characteristics and classification of injury, information on long term consequences of SCI/D and additional guidance on how to manage autonomic dysreflexia. Information on how to accommodate hand impairments that result in difficulty taking notes and how to include power wheelchair users in the sessions were incorporated in the materials for group sessions and group leaders. Minor modifications were made to the patient education materials to provide information on fluid restrictions and disability-sensitive language. Additional resources suggested by panel members such as including an organization for winter sports and SCI/D specific dietary and exercise guidelines were incorporated. The final manual provides a combination of general information, practical tips, and resources to promote education and confidence for the MOVE! group leaders with participants with SCI/D. In general, the manual explains physiological and functional issues related to SCI/D and emphasizes similarities with other populations such as the importance of behavioral change. Expert panel feedback provided specific guidance contributing to manual improvement.

IMPACT:
The draft manual and educational materials will be used by SCI QUERI in its implementation study to extend the MOVE! program for Veterans with SCI/D.

PUBLICATIONS:
None at this time.


DRA: Brain and Spinal Cord Injuries and Disorders
DRE: Prevention
Keywords: Exercise, Obesity, QUERI Implementation, Spinal cord injury
MeSH Terms: none

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