Staying Pressure Injury Free: The Role of Modifiable Behaviors

Published:March 04, 2022DOI:



      To investigate the association of behavioral factors with retrospective reports of staying free from pressure injuries (PIs) during a 12-month period for people with chronic spinal cord injury (SCI).


      Cross-sectional survey.


      Data collection was completed at an academic medical center in the Southeastern United States in collaboration with a specialized treatment center and 2 public health registries that use population-based approaches to identify all incident cases of SCI within the state.


      The participant cohort was composed of 3817 adults (N=3817) with traumatic SCI of at least 1-year duration.


      Not applicable.

      Main Outcome Measures

      Self-reported recall of staying PI-free for 12 months vs having 1 or more PIs.


      Among the 3817 participants, 74% were male, 76% were non-Hispanic White, and mean age was 48 years, with an average of 12 years post SCI. Based on self-report assessment, 67% reported being PI-free in the past year. After controlling for the demographic and injury characteristics, we found that those in the clinical cohort and those who reported healthy diets and planned exercise at least once a week were more likely to be PI-free; being underweight and high frequency of prescription medication use for spasticity, pain, and depression were negatively associated with being PI-free. Smoking, alcohol use, nonmedical substance use, and prescription medication misuse were not statistically significant in the multivariate model.


      There are several significant behavioral predictors of being PI-free, and consideration of these factors may be used to develop tailored strategies to promote healthy skin maintenance and the prevention of multiple, severe, and recurrent PI.


      List of abbreviations:

      OR (odds ratio), PI (pressure injury), SCI (spinal cord injury), SRA (self-report assessment)
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