Self-management interventions for skin care in people with a spinal cord injury: part 1—a systematic review of intervention content and effectiveness

Abstract

Study designSystematic review.ObjectivesTo review the content and effectiveness of skin care self-management interventions for people with SCI.SettingInternational.MethodsWe searched electronic bibliographic databases, trial registers, and relevant reference lists. Eligibility criteria for the reviews of intervention content and effectiveness were identical with the exception of study design. The review of intervention content included non-randomized and randomized controlled trials (RCTs). The review of effectiveness included RCTs. A Behavior Change Technique (BCT) taxonomy of 93 BCTs was used to code intervention content. Intervention effects on outcomes of interest are summarized descriptively. Effect sizes were calculated, and the Cochrane risk of bias tool applied.ResultsIn all, 15 studies testing 17 interventions were included in the review of intervention content. Interventions in these studies included 28 BCTs. The most common were “instructions on how to perform behavior” (16 interventions), “credible source” (12 interventions), and “social support (unspecified)” (9 interventions). Ten RCTs were included in the review of intervention effectiveness and they measured knowledge, self-efficacy, and skills relating to skin care/pressure ulcer (PU) prevention, skin care behaviors, skin status (PU prevalence, severity, and time to PU), and health-care utilization for skin problems. Evidence to support intervention effects on these outcomes was limited, particularly for clinical outcomes. Risk of bias assessments was often inconclusive due to poor reporting.ConclusionsThere is potential to design SCI skin care interventions that include currently untested BCTs. Further research and better consistency in outcome measurements and reporting are required to synthesize evidence on effectiveness.

Models of Telehealth Service Delivery in Adults With Spinal Cord Injuries: Scoping Review

“…One recent RCT [ 72 ] on health-related quality of life and satisfaction of patients with SCI and pressure injuries receiving real-time multidisciplinary videoconference consultations (video-telehealth) found videoconference-based care to be a safe and efficient way of managing pressure injuries, particularly for those individuals requiring long-term follow-up care and living far from the wound specialists. A total of 2 systematic reviews [ 55 , 56 ] and 1 scoping review [ 57 ] identified evidence to inform the development of telehealth techniques used to prevent, treat, and self-manage pressure ulcers in patients with SCI following discharge. One qualitative study that used semistructured interviews [ 34 ] and 1 modeled analysis [ 58 ] reported on patients’ experience using an educational mobile app for pressure ulcer prevention and evaluated costs and savings associated with telehealth services for preventing and treating pressure ulcers, respectively.…”

Development of Smart Clothing to Prevent Pressure Injuries in Bedridden Persons and/or with Severely Impaired Mobility: 4NoPressure Research Protocol

“…The current literature points towards a new paradigm for treating and preventing PIs, including both pragmatic and health technology-based solutions, through the combination of different clinical approaches [59][60][61]. Despite the increase in clinical healthcare technology (CHT) innovation applied in PI prevention in recent years [62][63][64], solutions such as interface map pressure, telemedicine, and educational technologies (among others) have demonstrated moderate effectiveness in addressing a subset of risk factors [64][65][66].…”

Challenges to building and maintaining partnership in the prevention and treatment of pressure injuries in spinal cord injury: a qualitative study of health professionals’ views

“…When a pressure injury develops, the responsibility should not be simply attributed to a lack of patient engagement [74]. It is important to acknowledge that not all pressure injuries can be prevented by behavioural measures [79,81,82], that the evidence in support of behavioural and educational interventions to prevent pressure injuries is mixed [83][84][85] and that the prevention of pressure injuries should be personalised and integrated into the complex self-management of the SCI [78,79,86,87]. This means, for instance, that HPs and health institutions must develop solutions that go beyond the personal partnership to better support patients who have different resources and attitudes toward self-management.…”