Towards accurate malnutrition identification in individuals with Spinal Cord Injury: a qualitative investigation

STUDY DESIGN: Exploratory qualitative descriptive study. OBJECTIVES: We aimed to explore how dietitians assess and diagnose malnutrition in individuals with spinal cord injury (SCI), limitations of current practice, and barriers to optimal practice, as well as improvements that could be made. SETTING: Twelve dietitians working in hospital, rehabilitation, and community contexts across Australia, the United Kingdom, the United States, Norway, South Africa, and New Zealand. METHODS: Semi-structured interviews were conducted via Microsoft Teams between April and August 2024. Data were recorded, transcribed, and analysed thematically using Braun and Clarke's six-step thematic analysis method. RESULTS: Participants primarily relied on generic screening tools due to institutional policy and ease of use. They expressed concerns about distinguishing obligatory post-injury weight changes from true undernutrition, and the minimal focus on overnutrition. Practical barriers to effective malnutrition identification included limited equipment access and staffing constraints, exacerbating screening challenges. Participants advocated for SCI-specific guidelines to improve diagnostic accuracy and reduce misclassification. CONCLUSIONS: Weight-centric approaches risk misclassifying malnutrition in SCI. Tailored frameworks that incorporate functional, clinical, and psychosocial factors are needed, alongside institutional support for successful implementation. Refined tools may standardise assessment and better address malnutrition's complex aetiology in SCI. Future research should explore and validate these approaches and evaluate their implementation in diverse SCI contexts.