Pressure ulcer risk factors in persons with spinal cord injury Part 2: the chronic stage

Abstract

Introduction: Pressure ulcers (PUs) are a common complication following spinal cord injury (SCI). Prevalence for persons in the chronic SCI stage varies between 15 and 30%. The risk assessment scales used nowadays were designed on pathophysiological concepts and are not SCI-specific. Recently, an epidemiological approach to PU risk factors has been proposed for designing an SCI-specific assessment tool. The first results seem quite disappointing, probably because of the level of evidence of the risk factors used. Objective: To determine PU risk factors correlated to the chronic stage of SCI. Materials and methods: Systematic review of the literature. Results: There are several PU risk factors for chronic SCI stage: socio-demographics, neurological, medical or behavioral. The level of evidence varies: it is quite high for the socio-demographics and neurological factors and low for behavioral factors. Discussion and conclusion: Behavioral risk factors (relieving the pressure, careful skin monitoring, smoking) are probably the ones for which a preventive strategy can be established. It is important to develop specific assessment tools for these behavioral risk factors to determine their relevance and evaluate the effect of therapeutic educational programs on persons with SCI.

Secondary health conditions in individuals aging with SCI: Terminology, concepts and analytic approaches

“…[13][14][15] (2) The frequency of certain health conditions increases with duration of SCI. These include chronic pain, 16 osteoporosis, 15,17 pressure sores 18 and kidney stones, 18 among many others. (3) Individual SHCs can be clustered into higher-order SHC constructs that may be useful for classifying and measuring these conditions in individuals with SCI, as well as other disabilities.…”

“…For instance, although the risk of pressure ulcers clearly increases dramatically at SCI onset, behavioral factors have a role in their development and course. 16 These behavioral factors can, in turn, be influenced by treatments that buffer the potential negative effects that other factors (such as age) have on secondary conditions (via intervention/prevention strategies, as indicated in Figure 1). Although a measurement model will help guide the selection of variables to assess, and ultimately may help us determine how best to combine these variables into composite factors, a conceptual model provides guidance regarding both (1) hypotheses to test and (2) analytic approaches needed to better understand the factors that impact the development and effects of SHCs.…”

The effects of phenol neurolysis of the obturator nerve on the distribution of buttock-seat interface pressure in spinal cord injury patients with hip adductor spasticity

“…Pressure-induced occlusion of capillary blood flow, resulting in tissue ischemia, is considered to be the primary cause. 3 Thus, the distribution and intensity of BSIP is very important, as is the duration of pressure, to SCI patients that use a wheelchair. Active patients with SCI spend many hours sitting in their wheelchairs.…”

“…1 The principal etiological factor in ulceration is improper pressure distribution. 2 Shear-force, age, 3 hygiene, 4 nutritional status, 5 general health status, 3 activity level, 1 tissue propertiesFincluding temperature, 6 moisture, 7 tissue viability 8 Fposture, deformities, and physiological factors are other etiological factors associated with pressure ulcers. Furthermore, sensory disorders, spastic or flaccid paralysis, coma, edema, and overuse of sedative medications also contribute to the formation of pressure ulcers.…”

Evaluating self-reported pressure ulcer prevention measures in persons with spinal cord injury using the revised Skin Management Needs Assessment Checklist: reliability study

“…2,3 Several of these factors cannot benefit from a targeted prevention. However, physical medicine and rehabilitation (PM&R) professionals can and must have an impact on some of these factors, right from the initial acute phase, such as behavioral factors, by educating patients on skin lesion prevention.…”