Screening, Diagnosis, and Treatment of Cardiometabolic Risk in Persons With Spinal Cord Injury/Disease: A Scoping...

To map and categorize evidence related to cardiometabolic disease (CMD) risk in persons with spinal cord injury/disease (SCI/D) and to assess the proportion of studies reporting on sociodemographic variables.

A scoping review of scientific evidence was conducted. MEDLINE, CINAHL, and EMBASE databases were searched using primary constructs (SCI/D, CMD) from inception to July 1, 2024.

Articles must meet the following criteria: (1) full-length article, (2) available in English, (3) SCI/D population aged ≥18 years, and (4) diagnosed CMD and/or evaluated CMD strategies/interventions.

The following information was extracted from the included articles: title, country in which the study was conducted, participant characteristics, sociodemographic variables reported, objective/purpose statement, study design, study type, intervention type, CMD risk factors evaluated, assessment time point(s), additional non-CMD outcome measures, use of clinical practice guidelines for risk stratification, summary of results, and report of clinical implications.

Of the 1726 studies screened, 120 met the inclusion criteria. Definitions from the Users' Guide to the Medical Literature were used to categorize studies under Diagnosis (n=75; 62.5%), Therapy (n=27; 22.5%), Prognosis (n=14; 11.7%), and Harm (n=4; 3.3%). Diagnosis studies commonly assessed the presence/absence of CMD using screening tools or biomarkers, although only 25 (20.7%) reported on sociodemographic variables, of which race (24.0%), ethnicity (17.3%), and education (13.3%) were most frequently reported. Positive findings for reducing the risk of obesity, hypertension, dyslipidemia, and diabetes mellitus were found across Therapy studies. Most (85.2%) incorporated health-promoting behaviors such as physical activity, nutritional counseling, and behavior change interventions. Four studies (14.8%) evaluated different pharmacologic treatments (atorvastatin, fenofibrate, α-lipoic acid, semaglutide) to target CMD risk factors.

Most of the literature on CMD in persons with SCI/D pertains to Diagnosis, reinforcing the increased prevalence and risk compared with the general population. Physical activity was the most studied therapeutic intervention to manage CMD after SCI/D; however, the limited number of therapy studies demonstrates a need to explore the efficacy of tailored interventions and multipronged approaches. Sociodemographic reporting was poor across all study types, highlighting a gap in understanding subgroup risk. Future research should prioritize addressing these gaps to improve CMD care.