Lifestyle intervention for adults with spinal cord injury: Results of the USC–RLANRC Pressure Ulcer Prevention Study

The Journal of Spinal Cord Medicine, 2019 · DOI: 10.1080/10790268.2017.1313931 · Published: January 1, 2019

Simple Explanation

This study investigated whether a lifestyle-based intervention could reduce the occurrence of severe pressure injuries in adults with spinal cord injury (SCI). Medically serious pressure injuries (MSPrIs) are a common and costly complication of SCI. The intervention, called the Pressure Ulcer Prevention Program (PUPP), involved healthcare professionals providing in-home visits and phone support over 12 months. It targeted socioeconomically disadvantaged individuals with a history of MSPrIs and focused on integrating preventive measures into their daily routines. The study found that the intervention did not significantly reduce the rate of MSPrIs compared to standard care. The researchers suggest that the complex and chaotic lives of the participants, along with a lack of statistical power, may have contributed to this result.

Study Duration

24 Months

Participants

N=166 for RCT component, N=66 in nonrandomized control group. Adults with SCI, with history of one or more MSPrIs over the past 5 years

Evidence Level

RCT

Key Findings

1
The lifestyle intervention (PUPP) did not significantly reduce the annualized incidence rates of medically serious pressure injuries (MSPrIs) in adults with SCI compared to standard care.
2
Participants in both the intervention and control groups showed significant improvements in various quality-of-life measures, including physical functioning, role limitations, social functioning, pain, and depression.
3
A higher risk level at baseline (history of multiple MSPrIs) was the strongest predictor of new MSPrIs during the study period.

Research Summary

This randomized controlled trial (RCT) evaluated the effectiveness of a 12-month lifestyle-based intervention (PUPP) in preventing medically serious pressure injuries (MSPrIs) among adults with spinal cord injury (SCI). The study included a non-randomized control group for comparison. The results showed no significant difference in annualized MSPrI rates between the intervention and control groups. However, both groups experienced improvements in quality-of-life measures. The study also identified baseline risk factors associated with MSPrI incidence. The authors conclude that the intervention's efficacy was inconclusive, possibly due to the complex challenges faced by the high-risk SCI population and limitations in statistical power. They emphasize the need for further research to identify effective strategies for MSPrI prevention in this population.

Practical Implications

Need for Targeted Interventions

Future interventions should be more tailored to address the complex life circumstances and social determinants of health affecting high-risk SCI populations.

Importance of Risk Assessment

Regular risk assessments are crucial for identifying individuals at high risk of developing MSPrIs and for implementing appropriate preventive measures.

Caution in Measuring PrIs

Researchers should exercise caution in measuring PrIs, considering multiple sources of information to improve data reliability.

Study Limitations

1
Lack of statistical power due to lower-than-expected MSPrI incidence rates.
2
Limited generalizability to more typical SCI populations with lower MSPrI rates.
3
The lack of a randomized no-contact control group obscured the effects of regular phone interviews administered in the RC condition.

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