Preventing recurrent pressure ulcers in veterans with spinal cord injury: impact of a structured education and follow-up intervention.

Author(s): Rintala DH, Garber SL, Friedman JD, Holmes SA

Affiliation(s): Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA. drintala@bcm.tmc.edu

Publication date & source: 2008-08, Arch Phys Med Rehabil., 89(8):1429-41.

Publication type: Randomized Controlled Trial; Research Support, U.S. Gov't, Non-P.H.S.

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 (19.6 mo, 10.1 mo, 10.3 mo; 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.