Developing a Model of Care for Healing Pressure Ulcers With Electrical Stimulation Therapy for Persons With Spinal Cord Injury

Abstract

Background: Electrical stimulation therapy (EST) has been shown to be an effective therapy for managing pressure ulcers in individuals with spinal cord injury (SCI). However, there is a lack of uptake of this therapy, and it is often not considered as a first-line treatment, particularly in the community. Objective: To develop a pressure ulcer model of care that is adapted to the local context by understanding the perceived barriers and facilitators to implementing EST, and to describe key initial phases of the implementation process. Method: Guided by the Knowledge-to-Action (KTA) and National Implementation Research Network (NIRN) frameworks, a community-based participatory research (CBPR) approach was used to complete key initial implementation processes including (a) defining the practice, (b) identifying the barriers and facilitators to EST implementation and organizing them into implementation drivers, and (c) developing a model of care that is adapted to the local environment. Results: A model of care for healing pressure ulcers with EST was developed for the local environment while taking into account key implementation barriers including lack of interdisciplinary collaboration and communication amongst providers between and across settings, inadequate training and education, and lack of resources, such as funding, time, and staff. Conclusions: Using established implementation science frameworks with structured planning and engaging local stakeholders are important exploratory steps to achieve a successful sustainable best practice implementation project.

Using a Modified ADAPTE Process to Enable Effective Implementation of Electrical Stimulation Therapy for Treating Pressure Ulcers in Persons With Spinal Cord Injury

“…[19][20][21] Despite strong evidence and recommendations by many best practice guidelines, the therapy continues to be unused by frontline community providers due to a number of perceived barriers expressed by a group of local stakeholders. 22 Given these findings, it became apparent that the adaptation process could facilitate the necessary details to enable effective implementation and ensure that the adaptation reflects the local context.…”

“…Furthermore, a preliminary pressure injuries model of care using EST as a treatment for healing was developed by the expert panel. 22 Step 2: Establishing an organizing committee, and adaptation team. An organizing committee comprised of 6 researchers from Western University, Lawson Health Research Institute, and Saint Elizabeth Health Care led the adaptation initiative.…”

“…PIC is a specialized interdisciplinary team that was specifically developed after an EST model of care was created during the exploration phase of this study. 22 Specific clinicians were chosen to be members of the PIC team given their experience working with one another and their expertise in working with individuals with SCI.…”

“…Over a 3-month period, the organizing committee prepared for the 2-day ADAPTE workshop at Western University and for subsequent meetings with the PIC team. Information regarding the initiative, including the barriers and facilitators to implementing EST that were collected in phase 1 22 and resources related to the application of EST, was shared with the group to review in advance. The workshop was held on May 17-18, 2015.…”

“…Each member of the adaptation team was then asked to articulate the challenges and opportunities with working in their health care setting and how it may affect the implementation of EST. The team then reviewed the model of care, 22 and discussed issues that might arise as the community aspects of this model are operationalized, with the goal of developing a process map.…”