Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 2 , Pages 213-231, February 2009

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

  • Mary Ann Regan, RN, BScN

      Affiliations

    • St. Joseph's Health Care-Parkwood Hospital, London, ON, Canada
    • Corresponding Author InformationReprint requests to Mary Ann Regan, RN, BScN, Room C401, Parkwood Hospital, 801 Commissioners Rd E, London, ON, Canada N6C 5J1
    • ,
  • Robert W. Teasell, MD, FRCPC

      Affiliations

    • St. Joseph's Health Care-Parkwood Hospital, London, ON, Canada
    • Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
    • Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, ON, Canada
    • ,
  • Dalton L. Wolfe, PhD

      Affiliations

    • St. Joseph's Health Care-Parkwood Hospital, London, ON, Canada
    • Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
    • Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, ON, Canada
    • ,
  • David Keast, MD, FCFP

      Affiliations

    • St. Joseph's Health Care-Parkwood Hospital, London, ON, Canada
    • Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
    • Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, ON, Canada
    • ,
  • William B. Mortenson, MSc, BScOT

      Affiliations

    • Occupation Therapy, Long-Term Care, Vancouver Coastal Health, Vancouver, BC, Canada
    • ,
  • Jo-Anne L. Aubut, BA

      Affiliations

    • Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, ON, Canada
    • ,
  • Spinal Cord Injury Rehabilitation Evidence Research Team

Abstract 

Regan MA, Teasell RW, Wolfe DL, Keast D, Mortenson WB, Aubut JL, for the Spinal Cord Injury Rehabilitation Evidence Research Team. A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury.

Objective

To systematically review evidence on the prevention and treatment of pressure ulcers in those with a spinal cord injury (SCI).

Data Sources

For this evidence-based review, the following data sources were used: MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO.

Study Selection

To be selected for inclusion in the current review, there had to have been an intervention, studies had to have 3 or more subjects, and 50% or more of the participating group had to have an SCI.

Data Extraction

Data extracted included study design, subject demographics, inclusion and exclusion criteria, study type, sample size, outcome measures used, and study results.

Data Synthesis

Articles selected for this review were organized into 1 of 2 categories: prevention or treatment. Within each broad category, several smaller ones were created, and articles were grouped according to the prevention (direct or indirect) or treatment intervention discussed.

Conclusions

Of the 26 articles selected for inclusion in the systematic review, 7 were randomized controlled trials (RCTs) that dealt with treatment for pressure ulcers, and there was 1 RCT on prevention. Despite the cost-effectiveness of prevention, little research exists on preventative interventions, and what does exist is mostly level 4 evidence. More research is needed for both prevention and treatment, but especially the former.

Key Words: Paraplegia, Pressure ulcer, Quadriplegia, Rehabilitation

List of Abbreviations: HD, hydrocolloid dressing, HVPC, high-voltage pulsed current, HVPGS, high-voltage pulsed galvanic stimulation, IT, ischial tuberosity, MDT, maggot debridement therapy, NAC, Needs Assessment Checklist, NMES, neuromuscular electrical stimulation, PEDro, Physiotherapy Evidence Database Scale, PUSH, Pressure Ulcer Scale for Healing, RCT, randomized controlled trial, SCI, spinal cord injury, SCIRE, Spinal Cord Injury Rehabilitation Evidence, PTCo2, transcutaneous oxygen tension, US, ultrasound, UVC, ultraviolet C radiation

 

 Supported by the Ontario Neurotrauma Foundation (grant no. 2007-SCI-SCIRE-528) and the Rick Hansen Man in Motion Foundation (International Collaboration on Repair Discoveries (ICORD) grant no. Rick Hanson 2008-13).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

PII: S0003-9993(08)01553-0

doi:10.1016/j.apmr.2008.08.212

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 2 , Pages 213-231, February 2009

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