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Preventing Pressure Ulcers in Veterans with Spinal Cord Injury
Bombardier CH, Guihan ML, Garber SL. Preventing Pressure Ulcers in Veterans with Spinal Cord Injury. Paper presented at: American Association of Spinal Cord Injury Psychologists and Social Workers Annual Conference; 2005 Sep 1; Las Vegas, NV.
Objectives: The purpose of this project was to evaluate the effect of an educational and cognitive behavioral telephone counseling intervention based on the Stages of Change Model in reducing recurrent pressure ulcers in veterans with SCI. Pressure ulcers are a serious, costly, and life-long complication of spinal cord injury (SCI). No other study has shown that prevention is a viable strategy.Methods: Veterans admitted to 6 VA SCI Centers for treatment of a severe (Stage III/IV) pelvic pressure ulcers were randomly assigned to either Intervention (n = 33) or Customary Care (n = 31). On admission, interviewers collected information on demographics, SCI/ulcer characteristics, co-morbidities, locus of control, pressure ulcer knowledge, readiness-to-change, and health beliefs/practices. Primary outcomes included development of another p elvic pressure ulcer within 18 months of discharge following healing (Y/N) and time to recurrence. Results: Accrual into the study did not meet expectations because almost 50% of those enrolled left the hospital with the study ulcer unhealed or were discharged with inadequate notice. Considerable variability in practice (e.g., LOS, receipt of medical vs. surgical treatment and sitting time prior to discharge) was observed. In addition, a significantly shorter median time to recurrence for both groups (4 vs. 9 months compared to earlier work) was observed. Because of recruitment issues, the study was closed. Using available data, a multi-variate logistic regression indicated that the strongest predictors of pressure ulcer recurrence included (in order of importance): African American race, higher scores on the Charlson Co-Morbidity Index and the Salzburg Pres sure Ulcer Risk Assessment, and longer sitting time at discharge. Further analyses will be conducted to determine whether other factors act as mediators with race in predicting ulcer recurrence. Implications: These data indicate areas for additional intervention including targeting those with co-morbidities and/or minority status. Impacts: This project had the potential to reduce the prevalence of pressure ulcers and costly hospitalization and surgery and to result in model programs for preventing recurrence. We are confident that when our current data are published we will have an excellent foundation for future studies on this most critical topic.