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

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.

Key Words: Patient education, Pressure ulcer, Rehabilitation, Spinal cord injuries

List of Abbreviations: AIS, American Spinal Injury Association Impairment Scale, CAI, computer-assisted instruction, CI, confidence interval, LOS, length of stay, MEDVAMC, Michael E. DeBakey Veterans Affairs Medical Center, MS, multiple sclerosis, OR, odds ratio, SCI, spinal cord injury, SCI/D, spinal cord injury or dysfunction