Preventing Recurrent Pressure Ulcers in Veterans With Spinal Cord Injury: Impact of a Structured Education and Follow-Up Intervention

Rintala, Diana H.; Garber, Susan L.; Friedman, Jeffrey D.; Holmes, Sally Ann

doi:10.1016/j.apmr.2008.01.015

Cited by 70 publications

(52 citation statements)

References 34 publications

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“…In a second publication on this study, the authors focused on the effect of educational programs on PU recurrence with a positive effect of an individualized educational program with a structured follow-up on the time delay before PU recurrence. 48 Finally, it is necessary to discuss the efficacy of an educational strategy that would require the creation and validation of an evaluation tool. A scale allowing evaluation of the knowledge of SCI patients on skin risk factors and PU prevention was recently published in the English language.…”

Section: Perspectivesmentioning

confidence: 99%

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

Gélis

Dupeyron

Legros³

et al. 2009

Spinal Cord

113

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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.

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Section: Perspectivesmentioning

confidence: 99%

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

Gélis

Dupeyron

Legros³

et al. 2009

Spinal Cord

113

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“…For instance, the study by Rintala et al 12 tested the hypothesis that enhanced education after pressure ulcer surgery would result in fewer recurrences. Although only tested in 38 SCI subjects, the group that received individualized education was identified to have a longer average time to ulcer recurrence than SCI subjects without education.…”

Section: Discussionmentioning

confidence: 99%

“…The differences in the number of patients with poor (0-8), average (9)(10)(11)(12), and good knowledge (13)(14)(15)(16)(17)(18)(19)(20) between the different age classifications (age at injury) were calculated using a w 2 or Fisher's exact test as appropriate.…”

Section: Statisticsmentioning

confidence: 99%

How does knowledge about spinal cord injury-related complications develop in subjects with spinal cord injury? A descriptive analysis in 214 patients

Thietje¹,

Giese

Pouw

et al. 2010

Spinal Cord

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Study design: Monocentric cohort study. Objective: To investigate the acquisition of knowledge about spinal cord injury (SCI)-related complications in SCI patients. Setting: Level 1 trauma center. Methods: All patients with a traumatic or non-traumatic SCI were included in the study. Data were collected at admission, post-admission at 1 and 3 months and post-discharge at 6, 18 and 30 months. The discharge of all patients was between 3 and 6 months post-admission. Knowledge about pressure ulcers and bladder management was tested using the 'Knowledge' score. This score has a minimum and maximum of 0 and 20 points. To detect differences across the multiple time intervals, the Friedman test was used. Differences in the number of patients with poor (0-8), average (9-12) and good knowledge (13-20) between the different age classifications (age at injury) were calculated using a w 2 -test. Results: A total of 214 patients were included. At discharge subjects had increased their knowledge score to 11.2 compared with 5.4 on admission (Po0.001). After 30 months, however, the mean score decreased to 10.8 points. At the time of discharge, the number of patients who achieved poor, average or good knowledge were 48 (22.4%), 65 (30.4%) and 101 (47.2%), respectively. Subjects of B50 years old and tetraplegics had better (Po0.001) knowledge compared with subjects of B50 years old and paraplegics, respectively. Conclusion: In this study, less than 50% of SCI patients had good knowledge about bladder management and pressure ulcers after being discharged.

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“…Our study confirms previous findings that history of pressure ulcers is a risk factor for recurrent pressure ulcers. 12,13 Previous studies have proposed followup programs and educational measures to prevent new pressure ulcers. 9,12 Regular assessment of seating pressure at the seating clinic in combination with education has previously shown favourable outcome in clinical studies.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing optimal seating pressure after spinal cord injury

et al. 2013

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Study design: Retrospective, cross-sectional design. Objectives: To identify factors that predict unsatisfactory seating pressure in spinal cord-injured (SCI) individuals. Setting: Seating Clinic at the University Hospital, Norway. Methods: All wheelchair users with traumatic SCI hospitalized between 1 January 2007 and 31 December 2010 were included. Individual assessment by a team was performed. To measure seating pressure, a computerized seating pad with sensing points 40 Â 40 cm was used. Primary end points were defined as satisfactory or unsatisfactory seating position based on measured pressure (more or less 100 mm Hg), clinical findings and physical activity level. To explore possible risk factors for high seating pressure, both univariate and multivariate regression analysis were performed. Results: A total of 75 persons with SCI were assessed, 39 (52%) with unsatisfactory result. Statistical analysis revealed that use of manual wheelchair (odds ratio (OR) ¼ 6.86, confidence interval (CI) 1.77-26.63) and history of pressure ulcer (OR ¼ 8.47, CI 2.46-29.13) significantly increase the risk of unsatisfactory seating pressure. Paraplegia caused significantly higher risk (OR ¼ 2.5, CI 0.99-6.34) in the univariate model, probably because the SCI with tetraplegia do prefer electrically powered wheelchairs. Conclusions: Use of manually driven wheelchairs and persons with previous pressure ulcer are at significant risk of high seating pressure and consequently developing new pressure ulcers. The patients from these subcategories need close follow-up regarding seating position and prevention of pressure ulcers.

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Preventing Recurrent Pressure Ulcers in Veterans With Spinal Cord Injury: Impact of a Structured Education and Follow-Up Intervention

Cited by 70 publications

References 34 publications

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

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

How does knowledge about spinal cord injury-related complications develop in subjects with spinal cord injury? A descriptive analysis in 214 patients

Factors influencing optimal seating pressure after spinal cord injury

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