The problem of preventing pressure ulcers in people with spinal cord injury

The Journal of Spinal Cord Medicine, 2019 · DOI: 10.1080/10790268.2018.1474682 · Published: January 1, 2019

Spinal Cord Injury Rehabilitation Dermatology

Simple Explanation

Pressure ulcers are a significant secondary complication for individuals with spinal cord injury, arising from prolonged pressure, shear, or compression, which leads to tissue damage. People with SCI are at high risk due to immobility and lack of sensation; ulcer treatment often requires prolonged bedrest, worsening social isolation and quality of life. Despite numerous studies and interventions, preventing pressure ulcers in this population remains challenging, with debates about preventability and the effectiveness of common clinical practices.

Study Duration

1 year intervention, 1 year follow-up

Participants

High-risk individuals with spinal cord injury

Evidence Level

Not specified

Key Findings

1
A comprehensive randomized controlled trial of ulcer prevention in SCI showed no significant differences in ulcer incidence despite lifestyle redesign interventions.
2
Studies show that interventions in inpatient settings report decreases in HAPU incidence of 25% to 30%, but these are transient and not sustained after the intervention ends.
3
Existing studies have methodological deficiencies, and their generalizability to people with SCI is highly uncertain because this population is rarely included in ulcer prevention studies.

Research Summary

Pressure ulcers are a common and costly complication of spinal cord injury (SCI), with controversy surrounding their precise mechanisms and prevention. Research suggests that commonly used clinical practices, like repositioning and nutritional supplementation, have insufficient evidence to support their effectiveness in preventing ulcers in people with SCI. Future research should focus on identifying which patients are most/least likely to benefit from preventive interventions and address patient, provider, and system-level factors impacting adherence to preventive care.

Practical Implications

Targeted Interventions

Better information is needed to target preventive interventions effectively, considering factors like income, race/ethnicity, and healthcare system engagement.

Adherence Measures

Healthcare systems should prioritize standardized measures of non-adherence to understand and address patient engagement in their own care.

Comprehensive Strategies

Address pressure ulcers with patient, provider, and system-level strategies, adapting successful HAPU prevention approaches for community-acquired ulcers.

Study Limitations

1
The generalizability of existing studies to people with SCI is highly uncertain.
2
Low power, small effect sizes, and lack of evidence in the general population limit the development of a one-size-fits-all solution.
3
The current focus on patient behavior minimizes the importance of biomechanical and genetic factors in ulcer development.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury