A latent structural equation model of risk behaviors and pressure ulcer outcomes among people with spinal cord injury

The 2022 Update on Pressure Injuries: A Review of the Literature

GENERAL PURPOSE

To review six articles published in 2022 that provide important new data or change how clinicians may think about pressure injuries.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:1. Identify evidence-based risk factors for the development of pressure injuries (PIs).2. Distinguish the predictors for PI development that prompted intervention.3. Identify inconsistencies in documented stages of PIs.4. Explain the impact of staffing on PI development rates.

Staying Pressure Injury Free: The Role of Modifiable Behaviors

OBJECTIVE

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).

DESIGN

Cross-sectional survey.

SETTING

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.

PARTICIPANTS

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

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

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

RESULTS

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.

CONCLUSIONS

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.

Indicators of Quality of Care in Individuals With Traumatic Spinal Cord Injury: A Scoping Review

STUDY DESIGN

Scoping review.

OBJECTIVES

To identify a practical and reproducible approach to organize Quality of Care Indicators (QoCI) in individuals with traumatic spinal cord injury (TSCI).

METHODS

A comprehensive literature review was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL) (Date: May 2018), MEDLINE (1946 to May 2018), and EMBASE (1974 to May 2018). Two independent reviewers screened 6092 records and included 262 full texts, among which 60 studies were included for qualitative analysis. We included studies, with no language restriction, containing at least 1 quality of care indicator for individuals with traumatic spinal cord injury. Each potential indicator was evaluated in an online, focused group discussion to define its categorization (healthcare system structure, medical process, and individuals with Traumatic Spinal Cord Injury related outcomes), definition, survey options, and scale.

RESULTS

A total of 87 indicators were identified from 60 studies screened using our eligibility criteria. We defined each indicator. Out of 87 indicators, 37 appraised the healthcare system structure, 30 evaluated medical processes, and 20 included individuals with TSCI related outcomes. The healthcare system structure included the impact of the cost of hospitalization and rehabilitation, as well as staff and patient perception of treatment. The medical processes included targeting physical activities for improvement of health-related outcomes and complications. Changes in motor score, functional independence, and readmission rates were reported as individuals with TSCI-related outcomes indicators.

CONCLUSION

Indicators of quality of care in the management of individuals with TSCI are important for health policy strategists to standardize healthcare assessment, for clinicians to improve care, and for data collection efforts including registries.

'I forget to do pressure relief': Personal factors influencing the prevention of secondary health conditions in people with spinal cord injury, South Africa

BACKGROUND

Across the lifespan, people with spinal cord injury (SCI) may experience preventable secondary health conditions (SHCs) such as pressures sores, muscle spasms and urinary tract infections (UTIs). Some factors influencing prevention of SHCs include social support, poor access to care and the prevention style of individuals. There is limited research on these factors.

OBJECTIVE

To explore personal factors influencing the prevention of SHCs in people with SCI.

METHOD

An explorative qualitative study included participants recruited in an outpatient department at a rehabilitation hospital. Semi-structured interviews were conducted with patients with SCI. Interviews were transcribed verbatim. Data analysis was conducted using content analysis.

RESULTS

Seventeen individuals with SCI were interviewed. From the interview analysis, six personal factors were identified, namely, socio-economic status; mental well-being (forgetfulness, beliefs, attitude); lack of knowledge of SHCs and prevention; lifestyle choices and practising prevention care; patient activation (self-management, problem-solving, resilience, self-awareness, help-seeking behaviour) and owning an appropriate assistive device.

CONCLUSION

Socio-economic status, mental well-being, knowledge of SHCs and prevention care, behaviour patterns, patient activation and owning an appropriate assistive device can influence prevention of SHCs. To enhance patient-oriented care, a model of care for people with SCI should consider these factors when developing prevention strategies. Future research could look into identifying environmental factors that influence the prevention of SHCs in people with SCI.

CLINICAL IMPLICATIONS

Tailored prevention strategies need to be developed, health professionals must ask patients about individual factors that may be barriers or facilitators to preventing secondary health conditions.

Health factors and spinal cord injury: a prospective study of risk of cause-specific mortality

STUDY DESIGN

Prospective cohort study.

OBJECTIVES

Identify the risk and protective factors of all-cause and cause-specific mortality among persons with traumatic spinal cord injury (SCI).

SETTING

Rehabilitation specialty hospital in the Southeastern United States.

METHODS

A prospective cohort study was conducted with 3070 adults with traumatic SCI who were a minimum of 1 year post-injury at assessment. Prospective data were collected in 1997-1998 and 2007-2010, with mortality determined as of 31 December, 2016. The deceased were classified into six categories based on underlying cause of death: septicemia, pneumonia and influenza, cancer, heart and blood vessel diseases, unintentional injuries, and all other causes. The competing risk analysis strategy applied to each of the specific causes.

RESULTS

There were a total of 803 observed deaths among the 2979 final study sample. After controlling for demographic and injury characteristics, general health, pressure ulcer history, and symptoms of infections were significantly associated with all-cause mortality. Except for cancer, they were also related with at least one of the specific causes of death, whereas orthopedic complications and subsequent injuries were unrelated to any cause.

CONCLUSIONS

Three health domains, global health, pressure ulcers, and symptoms of illness or infection, were significantly associated with mortality after SCI, and the patterns of association varied as a function of specific cause of death.