Preventing Recurrent Pressure Ulcers in Veterans With Spinal Cord Injury: Impact of a Structured Education and Follow-Up Intervention
Presented in part to the National Veterans Affairs Rehabilitation Research and Development Conference, October 1–3, 1998, Washington, DC; Thirteenth Annual Wound Care Symposium, October 8–11, 1998, Atlanta, GA; American Occupational Therapy Association, April 16–20, 1999, Indianapolis, IN; American Spinal Injury Association, April 19–21, 1999, Atlanta, GA; American Congress of Rehabilitation Medicine, October 19–23, 2000, Hilton Head Island, SC; and American Spinal Injury Association, May 3–6, 2002, Vancouver, BC, Canada.
Abstract
Rintala DH, Garber SL, Friedman JD, Holmes SA. Preventing recurrent pressure ulcers in veterans with spinal cord injury: impact of a structured education and follow-up intervention.
Objective
To test the hypothesis that enhanced education and structured follow-up after pressure ulcer surgery will result in fewer recurrences.
Design
Randomized controlled trial.
Setting
Veterans Affairs medical center.
Participants
Forty-nine veteran men with spinal cord injury or dysfunction were approached on admission for pressure ulcer surgery. Five never had surgery, 2 refused to participate, and one withdrew. Forty-one were randomized into 3 groups. Three participants' ulcers did not heal, so follow-up could not begin.
Interventions
Group 1 received individualized pressure ulcer education and monthly structured telephone follow-up (n=20); group 2 received monthly mail or telephone follow-up without educational content (n=11); and group 3 received quarterly mail or telephone follow-up without educational content (n=10). Follow-up continued until recurrence, death, or 24 months.
Main Outcome Measure
Time to pressure ulcer recurrence.
Results
Group 1 had a longer average time to ulcer recurrence or end of study than groups 2 and 3 (19.6mo, 10.1mo, 10.3mo; P=.002) and had a smaller rate of recurrence (33%, 60%, 90%; P=.007). Survival analysis confirmed these findings (P=.009).
Conclusions
Individualized education and structured monthly contacts may be effective in reducing the frequency of or delaying pressure ulcer recurrence after surgical repair of an ulcer.
Reprint requests to Diana H. Rintala, PhD, MEDVAMC (153), 2002 Holcombe Blvd, Houston, TX 77030
Supported by the Department of Veterans Affairs, Veterans Health Administration, Rehabilitation Research and Development Service (grant no. B1343-R).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.
ABSTRACT