Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Health and Rehabilitation Sciences

Supervisor

Bateman, Ali

2nd Supervisor

Wolfe, Dalton

Co-Supervisor

Abstract

Cardiometabolic disease (CMD) is an overlooked secondary complication in persons with spinal cord injury/disease (SCI/D), multiple sclerosis (MS), cerebral palsy (CP), and spina bifida (SB). Little is known about strategies to mitigate CMD risk in these populations, or the perspectives of patients, physiatrists, and primary care providers on the topic. A scoping review and mixed-methods study were conducted to explore the literature and lived experiences. Analysis of 120 studies revealed a dominant focus on CMD diagnosis, with a subset exploring therapeutic interventions to mitigate risk in the SCI/D population. Patients, physiatrists, and primary care providers differ in knowledge and confidence in CMD management and/or treatment provision. Lifestyle interventions and self-management strategies emerged as key approaches, but physical and economic barriers limit their adoption. Further research is needed to develop equitable, personalized interventions to mitigate CMD. Resource development and knowledge translation may help prioritize CMD in rehabilitation and primary care settings.

Summary for Lay Audience

Cardiometabolic disease (CMD) is a leading cause of death for people with spinal cord injury/disease (SCI/D), multiple sclerosis (MS), cerebral palsy (CP), and spina bifida (SB). CMD describes a group of health problems that increase the risk of heart disease, stroke, diabetes, and heart failure. While people with these neurological conditions are more likely to develop CMD, they are less likely to be properly screened, diagnosed, or treated. Little research has been done on strategies to reduce CMD risk in these populations, and we know even less about what patients, Physical Medicine and Rehabilitation Specialists (physiatrists), and Primary Care Providers (PCPs) think about CMD care and management. This thesis aimed to fill some of these knowledge gaps.

A scoping review was conducted to explore existing strategies for managing CMD in persons with SCI/D. Of the 120 studies analyzed, most focused on diagnosing CMD rather than preventing or treating it. Very few studies explored therapeutic interventions like promoting physical activity or healthy eating to reduce risk. Additionally, most studies failed to report sociodemographic information, leaving gaps in understanding how factors like income, education, and race may impact CMD risk or interventions to address it.

A mixed-methods study was also conducted to better understand patient and provider perspectives. This involved a survey completed by 26 patients (with SCI/D, CP, MS, and SB), 11 physiatrists, and 13 PCPs, with some participants taking part in follow-up interviews. The findings revealed that patients, physiatrists, and PCPs have different levels of knowledge and confidence when it comes to managing CMD. Healthy lifestyle changes were seen as a key strategy for reducing risk, but many patients faced barriers, such as financial challenges and lack of access to services. Future research should explore interventions that promote healthy behaviours while considering the social and economic factors that influence a person’s ability to manage CMD. Creating more resources and educational opportunities may help patients, physiatrists, and PCPs work together to better prevent and manage CMD in these populations. A national effort is needed to close these gaps and improve CMD care for people with neurological conditions.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Download

Share

COinS