A Comparison of Stakeholder Perceptions and Clinical Assessment of Cardiometabolic Disease and Risk Determinants after Spinal Cord Injury (SCI)

The prevalence of overweight/obesity as a cardiometabolic disease (CMD) risk determinant following SCI is daunting, ranging from 55% to 83% of the population. A significant shift in body composition within the first year after injury is ultimately associated with diminished work capacity, musculoskeletal decline, pain, accelerated all-cause cardiovascular disease, and progressive life dissatisfaction. Prevalence of and risks imposed on the SCI population by other guideline-established CMD risk determinants (i.e., hypertension, dyslipidemia, and insulin resistance) exceed those reported in the non-disabled population. No evidence suggests that these medical hazards will resolve without a comprehensive understanding of risks that they pose for the SCI population. A collection of data by the NIDILRR SCI Model Systems ought to play a pivotal role in developing this understanding. However, a recent study by Model Systems and NIDILRR investigators obtained data that were at odds with objectively assessed risk prevalence, and their use will dramatically underestimate CMD population risk estimation and the need for disease oversight.

The aims for this study are:

1. Refine item wording for the five guideline-established CMS component risks that is stakeholder vetted for accuracy, clarity, and simplicity. In doing so, we expect enhanced understanding of these items through the elimination of technical language commonly used to define CMS component risks (i.e., dyslipidemia, insulin resistance, hypertension) lessening of confounds (i.e., confusion about hypertension from systemic cardiovascular disease versus episodic autonomic dysreflexia).
2. Determine whether there is agreement between
   
   1. health care professional-attributed, stakeholder-reported component risks for the CMD and
   2. component risks that are established by objective measurement. This aim is the first step in a process that examines whether these risks are guideline-evaluated by health care professionals, whether the message is communicated in a way that it is understood, and if the gravity of the information is being placed in proper perspective by both health care professionals and stakeholders.
3. Track subjects tested from Aim 2 at one-year intervals to determine whether clinically-assessed risk prevalence for the five CMS risk components and CMS diagnosis will worsen, and whether hazard estimation determined by health care professional-attributed, stakeholder-reported component risks also worsens.