A co-design project to develop, and assess the acceptability and feasibility of, an intervention to support prevention of weight gain and/or encourage weight reduction in people with Spinal Cord Injury within Specialist Spinal Injury Centres

Background There are over 50,000 people in the UK living with a Spinal Cord Injury (SCI), and 2,500 people acquiring a SCI annually. SCI is life changing, resulting in paralysis.

Changing body composition following SCI manifests itself as initial weight loss from muscle atrophying but turning later to significant weight gain and increased fat mass. This increases the risk of obesity-related diseases above that seen in the able-bodied population.

Research question Is it possible to co-design a feasible and acceptable weight management intervention for people with SCI?

Aims and Objectives To develop and assess the feasibility of a new intervention to deliver weight management support to people with SCI within Specialist Spinal Injury Centres.

Objectives are to: Undertake a scoping review of technology support for weight management interventions Co-design a weight management intervention with patients and health care professionals to be delivered both locally and/or remotely by Specialist Spinal Injury Centres Develop a training package of the intervention for staff in Specialist Spinal Injury Centres Assess the feasibility of using the intervention in practice Design an evaluation of the intervention for future research funding Methods The study consists of two parts.

Part 1: Using Hawkins et al's three-stage framework for co-designing interventions: Phase 1.

Evidence base and stakeholder consultation Scoping review to identify innovative technological methods for supporting weight management in the home Mapping exercise to describe current weight management practices at UK Specialist Spinal Injury Centres 20-36 staff and patient interviews to explore perceptions of weight management following SCI Phase 2.

Co-production 4 workshops involving patients and staff will review evidence and discuss ideal weight management programmes Design a prototype weight management programme through iterative processes of feedback and refinements Phase 3.

Prototyping Trial the intervention with 5-7 patients, receive feedback and create a revised version Qualitative interviews with staff and patients involved for feedback on feasibility and acceptability Part 2: Feasibility study of the new intervention The prototype will be refined after stage 1 and assessed in a different Specialist Spinal Injuries Centre with one staff member delivering to 5 patients.

Qualitative interviews with staff and patients involved will identify feasibility and acceptability of the intervention enabling further refinement In collaboration of key stakeholders, a future evaluation will be designed. This study will be undertaken as a part time PhD (0.8WTE) over 45 months.

Anticipated impact and dissemination The intervention will support people following SCI to prevent weight gain and/or lose weight in a safe and appropriate manner.

By producing better weight control, it may reduce the risk of obesity-related diseases such as diabetes and coronary heart disease.

Dissemination will be through scientific conferences such as Guttmann, ISCOS and MASCIP; journal articles and reports to spinal charities such as Aspire, Back Up and the Spinal Injuries Association will be produced. It will help to produce national guidance on best practice to support people with SCI.

It will contribute to business cases for appropriate dietetic provision within UK SCI centres.