Nutrition care in adults with spinal cord injuries and disorders with pressure injuries: A systematic review of clinical practice guidelines

Pressure injuries (PIs) are a common and costly complication in adults with spinal cord injuries and disorders (SCI/D), with a global prevalence of 32 % and a lifetime risk exceeding 85 % in Australia. Nutrition is a key factor in the prevention and management of PIs, supporting wound healing, immune function, and overall recovery. This systematic review evaluated the quality, scope, and methodological rigour of 17 international clinical practice guidelines (CPGs) published since 2010 that included nutrition recommendations for PIs in adults with SCI/D. Using the AGREE II and the AGREE-REX tools, this review assessed overall guideline quality and nutrition-specific recommendations mapped to the Nutrition Care Process domains. Seven CPGs were rated high quality with AGREE II, and three with AGREE-REX. While most guidelines focussed on nutrition interventions, limited detail was provided on assessment and monitoring. Considerable variation was found in the rigour and specificity of recommendations. These findings underscore a need for high-quality, SCI/D-specific guidelines that offer consistent, evidence-based, actionable nutrition guidance, particularly in the under-represented areas of assessment and monitoring, to better support PI prevention and treatment in this vulnerable population.