A Systematic Review of Therapeutic Interventions for Pressure Ulcers Following Spinal Cord Injury

Arch Phys Med Rehabil, 2009 · DOI: 10.1016/j.apmr.2008.08.212 · Published: February 1, 2009

Spinal Cord Injury Rehabilitation Dermatology

Simple Explanation

Pressure ulcers are a common and serious complication following spinal cord injury (SCI). They can negatively affect a person's physical, psychological, and social well-being and interfere with rehabilitation and community reintegration. This review examines existing research on interventions for both preventing and treating pressure ulcers in individuals with SCI. It looks at various strategies, including electrical stimulation, pressure relief techniques, wheelchair cushion selection, specialized seating clinics, education, and telerehabilitation. The review concludes that while prevention is more cost-effective, there is limited research on preventative interventions. More research is needed for both prevention and treatment, especially in the area of preventative strategies.

Study Duration

1980 to 2007

Participants

26 articles reviewed; interventional studies with a sample size of 3 or greater, and with at least half of the study population having a spinal cord injury

Evidence Level

Systematic Review

Key Findings

1
Electrical stimulation may decrease ischial pressures and increase blood flow in sacral and gluteal areas, potentially aiding in pressure ulcer prevention.
2
Forward leaning is the most effective pressure relief technique, whereas a short (15-30 second) vertical lift may not be effective.
3
Enhanced pressure ulcer prevention education is effective at helping individuals with SCI gain and retain knowledge; various cushions or seating systems are associated with potentially beneficial reductions in seating interface pressure.

Research Summary

Pressure ulcers remain a common and potentially serious lifelong secondary complication of SCI, impacting overall quality of life and disrupting various aspects of an individual's life. Many prevention studies reviewed had small sample sizes and low levels of evidence, highlighting the need for more rigorous research to determine effective preventative interventions. There is evidence to support electrical stimulation, ultrasound/ultraviolet C, pulsed electromagnetic energy, and occlusive hydrocolloid dressings as adjunctive therapies for treating pressure ulcers, but more research is still needed to assess treatment interventions.

Practical Implications

Clinical Practice

Implement forward leaning for pressure relief. Consider specialized seating assessments.

Further Research

Conduct rigorous research on pressure ulcer prevention strategies post-SCI.

Education

Provide enhanced pressure ulcer prevention education to individuals with SCI.

Study Limitations

1
Small sample sizes in many of the reviewed studies.
2
Low levels of evidence (Level 4) supporting many interventions.
3
Lack of direct evidence of pressure ulcer prevention associated with specific practices or cushion types.

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