Comparing Multicomponent Interventions to Improve Skin Care Behaviors and Prevent Recurrence in Veterans Hospitalized for Severe Pressure Ulcers

Guihan, Marylou; Bombardier, Charles H.; Ehde, Dawn M.; Rapacki, Lauren; Rogers, Thea; Bates‐Jensen, Barbara M.; Thomas, Florian P.; Parachuri, Rama; Holmes, Sally Ann

doi:10.1016/j.apmr.2014.01.012

Cited by 40 publications

(74 citation statements)

References 25 publications

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“…Prevention measures and appropriate treatment may reduce the incidence and impact of many of these HCs after SCI (9). To inform and optimize health policy programmes aiming at reducing the impact of prevalent morbidity after SCI, there is a need for contemporary evidence on the prevalence and severity of HCs as well as their treatment.…”

Section: Introductionmentioning

confidence: 99%

Health conditions in people with spinal cord injury: Contemporary evidence from a population-based community survey in Switzerland

Brinkhof¹,

Al-Khodairy²,

Eriks‐Hoogland³

et al. 2016

J Rehabil Med

112

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Background: Health conditions in people with spinal cord injury are major determinants for disability, reduced wellbeing, and mortality. However, population-based evidence on the prevalence and treatment of health conditions in people with spinal cord injury is scarce. Objective: To investigate health conditions in Swiss residents with spinal cord injury, specifically to analyse their prevalence, severity, co-occurrence, and treatment. Methods: Cross-sectional data (n = 1,549) from the community survey of the Swiss Spinal Cord Injury (SwiSCI) cohort study, including Swiss residents with spinal cord injury aged over 16 years, were analysed. Nineteen health conditions and their self-reported treatment were assessed with the spinal cord injury Secondary Conditions Scale and the Self-Administered Comorbidity Questionnaire. Prevalence and severity were compared across demographics and spinal cord injury characteristics. Co-occurrence of health conditions was examined using a binary non-metric dissimilarity measure and multi-dimensional scaling. Treatment rates were also examined. Results: Number of concurrent health conditions was high (median 7; interquartile range 4-9; most frequent: spasticity, chronic pain, sexual dysfunction). Prevalence of health conditions increased with age and was higher in non-traumatic compared with traumatic spinal cord injury. Spinal cord injury specific conditions co-occurred. Relative frequencies of treatment were low (median 44%, interquartile range 25-64%), even for significant or chronic problems. Discussion: A high prevalence of multimorbidity was found in community-dwelling persons with spinal cord injury. Treatment for some highly prevalent health conditions was infrequent.

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Section: Introductionmentioning

confidence: 99%

Health conditions in people with spinal cord injury: Contemporary evidence from a population-based community survey in Switzerland

Brinkhof¹,

Al-Khodairy²,

Eriks‐Hoogland³

et al. 2016

J Rehabil Med

112

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“…The 15 studies reviewed tested 17 different interventions. Fifteen control groups received standard care consisting in very limited or no contact with health-care professionals (HCPs) or intervention deliverers (10 studies [ 23 – 33 ]), and minimal education (five studies [ 22 , 34 – 38 ]). A description of intervention and control group treatments is in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Structured follow-up calls for data collection only. BCTs : social support (unspecified), credible source, and biofeedback Guihan [ 34 ], United States, RCT I: n = 72C: n = 72 Pool : Inpatients Sample : Individuals with recent SCI (≥6 months post injury) admitted for treatment of a stage III or IV pelvic ulcer To improve skin-protective behaviors and prevent skin worsening Starting at discharge or within 2 years from discharge 6 Months Prior to randomization b : Education in knowledge areas not conforming to guidelines, using a PU consumer guide. Standardized treatment components included seating evaluation (including pressure mapping, education on safe/effective transfers, and PU prevention strategies), nutritional assessment, skin care behavior demonstrations (pressure relief and skin checks), depression, substance abuse, bowel/bladder incontinence, and assessment of personal-care assistance I: Self-management (SM) sessions + motivational interviewing (MI): seven SM conference call sessions (45–60 min) on guideline-based skin care; problem solving and self-monitoring skills; community resource utilization; relaxation and mood management skills; relationships with providers; and development of action plans.…”

Section: Resultsmentioning

confidence: 99%

Self-management interventions for skin care in people with a spinal cord injury: part 1—a systematic review of intervention content and effectiveness

et al. 2018

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Study designSystematic review.ObjectivesTo review the content and effectiveness of skin care self-management interventions for people with SCI.SettingInternational.MethodsWe searched electronic bibliographic databases, trial registers, and relevant reference lists. Eligibility criteria for the reviews of intervention content and effectiveness were identical with the exception of study design. The review of intervention content included non-randomized and randomized controlled trials (RCTs). The review of effectiveness included RCTs. A Behavior Change Technique (BCT) taxonomy of 93 BCTs was used to code intervention content. Intervention effects on outcomes of interest are summarized descriptively. Effect sizes were calculated, and the Cochrane risk of bias tool applied.ResultsIn all, 15 studies testing 17 interventions were included in the review of intervention content. Interventions in these studies included 28 BCTs. The most common were “instructions on how to perform behavior” (16 interventions), “credible source” (12 interventions), and “social support (unspecified)” (9 interventions). Ten RCTs were included in the review of intervention effectiveness and they measured knowledge, self-efficacy, and skills relating to skin care/pressure ulcer (PU) prevention, skin care behaviors, skin status (PU prevalence, severity, and time to PU), and health-care utilization for skin problems. Evidence to support intervention effects on these outcomes was limited, particularly for clinical outcomes. Risk of bias assessments was often inconclusive due to poor reporting.ConclusionsThere is potential to design SCI skin care interventions that include currently untested BCTs. Further research and better consistency in outcome measurements and reporting are required to synthesize evidence on effectiveness.

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“…There is also a very high incidence of recurrence, with 20% of surgically repaired wounds recurring within 3 months of surgery [4]. The best predictor of a second pressure ulcer in the SCI population is the presence of a first pressure ulcer [5] [6].…”

Section: Introductionmentioning

confidence: 99%

Healing Wounds under Mechanical Stress: A Case Example

Hastings¹,

Shapiro²

2016

IJCM

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This paper challenges the concept that the essential element in wound healing is to offload pressure. We suggest a change in approach that recognizes the integumentary system as one which, like all other body systems, adapts to the stresses put upon it. We use a clinical case example to illustrate the use of intentional mechanical stress to promote wound healing and include a review of the relevant literature. The intent of this publication is to call for a new look at clinical practice regarding wound healing and to call for future research directed at investigation of this theory.

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Comparing Multicomponent Interventions to Improve Skin Care Behaviors and Prevent Recurrence in Veterans Hospitalized for Severe Pressure Ulcers

Cited by 40 publications

References 25 publications

Health conditions in people with spinal cord injury: Contemporary evidence from a population-based community survey in Switzerland

Health conditions in people with spinal cord injury: Contemporary evidence from a population-based community survey in Switzerland

Self-management interventions for skin care in people with a spinal cord injury: part 1—a systematic review of intervention content and effectiveness

Healing Wounds under Mechanical Stress: A Case Example

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