Doctors and nurses working in spinal cord injury centres have poor nutritional knowledge

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A survey, published in Spinal Cord, indicates that doctors and nurses working in spinal cord injury centres lack knowledge in certain areas of nutritional care for patients with spinal cord injuries, indicating a need for more structured nutritional information among doctors and nurses working in spinal cord centres.

The study authors, Samford Wong, Department of Nutrition and Dietetics, Stoke Mandeville Hospital, Aylesbury, UK, and others, reported that 40% of patients admitted to a UK spinal cord injury unit are malnourished and, according to a previous study of theirs, dietetic resources in spinal cord injury units are suboptimal. They added it was “imperative that frontline healthcare staff have sufficient knowledge in identifying patients at nutritional risk, so they can offer appropriate choices of treatment.”

To identify the nutritional knowledge (or lack thereof) of healthcare staff working in UK spinal cord centres, Wong et al sent, between January and March 2010, a 14-item questionnaire on nutritional care to doctors, nurses, and dieticians working in spinal cord injury centres across the UK. Of the 62 respondents, overall, 83% claimed to be aware of a ward-based nutritional screening tool. However, there were significant differences between the healthcare professionals in terms of awareness: 88.9% of dieticians vs. 77.8% of nurses vs. 50% of doctors were aware of such a tool (p=0.033).

Wong et al also noted gaps in the participants’ nutritional knowledge.  All doctors surveyed knew how to calculate body mass index, but only 38% of nurses knew how to do this calculation. Wong et al added: “Surprisingly, 49% of the participants thought that ≥20% weight loss was required to indicate malnutrition, meaning that <20% weight loss in three months would not be considered a risk. As doctors and nurses are normally responsible for referring patients for detailed nutritional assessment by dieticians, this is cause for concern as it suggests that malnutrition is likely to continue to be undetected and unmanaged.”

Furthermore, only a few of the healthcare professionals (30% of doctors, 17.1% of nurses, and 22.2% of dieticians) recognised that an overweight person would be at risk of malnutrition if they lost weight rapidly and, therefore, would be in need of nutritional supplements.

Wong et al reported that these “disappointing” results may be an overestimation of the nutritional knowledge of healthcare professionals working in a spinal cord centre as “individuals who thought they had a reasonable knowledge may have been more willing to complete the questionnaires.” They added: “Our results highlight the need for more thorough nutritional education of spinal cord injury healthcare professionals (and probably more widely in acute hospital settings) to address this aspect of patient care.”


Wong told Spinal News International: “Malnutrition is common after spinal cord injuries and it is associated with adverse clinical outcomes. Our data suggest appropriate dietetic intervention is of clinical advantage. Malnutrition will continue to be under-recognised and under-treated if dietetic provision remains limited in spinal cord injury centres. We recommend using a validated nutrition screening tool such as the Spinal Nutrition Screening Tool in identifying spinal cord injury patients at risk of malnutrition. In order to improve the efficacy of feeding and nutrition therapy for such patients, further education among professionals working in spinal cord injury centres is needed.”