The Incidence of Pressure Ulcers in People with Multiple Sclerosis and Persons Responsible for their Management

Cramp, A. Fiona L.; Warke, K; Lowe-Strong, Andrea

doi:10.7224/1537-2073-6.2.52

Cited by 6 publications

(3 citation statements)

References 19 publications

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“…As an example, mean values of 49.6% and 58.9% were reported in Belgium29 and Sweden,46 respectively. As PU practice is traditionally perceived to be the domain of the nursing profession14,24 it might be predicted that their knowledge would be higher than other professions. However, although small variations were seen between individual professions, overall comparison between nurses and AHPs indicated that they held similar levels of knowledge.…”

Section: Discussionmentioning

confidence: 99%

<p>An interprofessional approach to pressure ulcer prevention: a knowledge and attitudes evaluation</p>

Clarkson¹,

Worsley²,

Schoonhoven³

et al. 2019

JMDH

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Background: Pressure ulcers (PUs) are a major burden to individuals, impacting their physical, mental and social wellbeing. While PU prevention is traditionally regarded as a nursing issue, an interprofessional approach has been promoted as best practice. However, little is known about current practice or the knowledge and attitudes of the wider interprofessional team (IPT). Purpose: Pre-designed questionnaires were used to explore knowledge and attitudes with healthcare staff in the community. Methods: Questionnaires were disseminated to all healthcare staff within a community healthcare Trust predominantly via an online tool. Data were analyzed using descriptive and inferential statistics. Results: The median values of all professional groups demonstrated satisfactory attitudes (>75%) and levels of knowledge (>60%) to PU prevention. However, there were differences within and between groups. Management staff demonstrated the most positive attitude to PU prevention (89%), followed by occupational therapists (OTs) and healthcare assistants (HCAs) (87%, IQR: 75%→89%). OTs demonstrated the highest scores for knowledge (69%, IQR: 62%→73%), while healthcare and rehabilitation assistants scored the lowest (58%, IQR: 58%-64%). Conclusion: This study has demonstrated that the majority of healthcare staff in a UK community setting have satisfactory levels of knowledge and attitudes in relation to PU prevention overall. Nevertheless, there were some differences between groups, albeit non-significant. There were also differences between sub-themes of the questionnaires, indicating a greater focus of pressure ulcer treatment over prevention. While PU prevention is widely regarded to be a nursing issue, these findings provide some indication of the potential for an interprofessional approach.

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Section: Discussionmentioning

confidence: 99%

<p>An interprofessional approach to pressure ulcer prevention: a knowledge and attitudes evaluation</p>

Clarkson¹,

Worsley²,

Schoonhoven³

et al. 2019

JMDH

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“…For example, over 50% of Americans with spinal cord injuries develop at least one pressure ulcer during their lifetime [6]. The risk of developing pressure ulcers also affects other wheelchair users with central neurological conditions (eg, multiple sclerosis and cerebral palsy) [7,8] and elderly people who experience fragility associated with a major loss of mobility [9,10]. In addition to causing pain and infections and increasing mortality risk, a pressure ulcer may require hospitalization of 6 to 14 days [11,12] along with extended bedrest.…”

Section: Introductionmentioning

confidence: 99%

Development of a Web-Based Monitoring System for Power Tilt-in-Space Wheelchairs: Formative Evaluation

Campeau-Vallerand¹,

Michaud²,

Routhier³

et al. 2019

JMIR Rehabil Assist Technol

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BackgroundIn order to prevent pressure ulcers, wheelchair users are advised to regularly change position to redistribute or eliminate pressure between the buttocks region and the seat of the wheelchair. A power tilt-in-space wheelchair (allowing simultaneous pivoting of the seat and the backrest of the wheelchair toward the back or front) meets many clinical purposes, including pressure management, increased postural control, and pain management. However, there is a significant gap between the use of tilt as recommended by clinicians and its actual usage. A Web-based electronic health (eHealth) intervention, including a goal setting, monitoring, reminder, and feedback system of the use of power tilt-in-space wheelchairs was developed. The intervention incorporates behavior change principles to promote optimal use of tilt and to improve clinical postprocurement follow-up.ObjectiveThis study aimed to conduct a formative evaluation of the intervention prototype to pinpoint the functionalities needed by end users, namely, power wheelchair users and clinicians.MethodsOn the basis of an evaluation framework for Web-based eHealth interventions, semistructured interviews were conducted with power wheelchair users and clinicians. A content analysis was performed with a mix of emerging and a priori concepts.ResultsA total of 5 users of power tilt-in-space wheelchairs and 5 clinicians who had experience in the field of mobility aids aged 23 to 55 years were recruited. Participants found the Web interface and the physical components easy to use. They also appreciated the reminder feature that encourages the use of the tilt-in-space and the customization of performance goals. Participants requested improvements to the visual design and learnability of the Web interface, the customization of reminders, feedback about specific tilt parameters, and the bidirectionality of the interaction between the user and the clinician. They thought the current version of the intervention prototype could promote optimal use of the tilt and improve clinical postprocurement follow-up.ConclusionsOn the basis of the needs identified by power wheelchair users and clinicians regarding the prototype of a power tilt-in-space wheelchair monitoring system, 3 main directions were defined for future development of the intervention. Further research with new wheelchair users, manual tilt-in-space wheelchairs, various age groups, and family caregivers is recommended to continue the formative evaluation of the prototype.

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“…There are also significant economic costs related to increasing immobility and secondary complications since they increase the burden of care, delay rehabilitation and increase healthcare costs. It is estimated that approximately 15 % of people with MS will, at some point in time, develop a pressure sore [ 11 ], with treatment costs of a single pressure sore ranging from £1,064 to £24,214 [ 6 ]. The mean cost per wheelchair dependent patient is 4–5 times higher than an ambulatory patient [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Standing up in multiple sclerosis (SUMS): protocol for a multi-centre randomised controlled trial evaluating the clinical and cost effectiveness of a home-based self-management standing frame programme in people with progressive multiple sclerosis

et al. 2016

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BackgroundMultiple sclerosis (MS) is an incurable, unpredictable but typically progressive neurological condition. It is the most common cause of neurological disability in young adults. Within 15 years of diagnosis, approximately 50 % of affected people are unable to walk unaided, and over time an estimated 25 % depend on a wheelchair. Typically, people with such limited mobility are excluded from clinical trials. Severely impaired people with MS spend much of their day sitting, often with limited ability to change position. In response, secondary complications can occur including: muscle wasting, pain, reduced skin integrity, spasms, limb stiffness, constipation, and associated psychosocial problems such as depression and lowered self-esteem. Effective self-management strategies, which can be implemented relatively easily and cheaply within people’s homes, are needed to improve or maintain mobility and reduce sedentary behaviour. However this is challenging, particularly in the latter stages of disease. Regular supported standing using standing frames is one potential option.Methods/DesignSUMS is a pragmatic multi-centre randomised controlled trial evaluating use of Oswestry standing frames with blinded outcome assessment and full economic evaluation. Participants will be randomly allocated (1:1) to either a home-based, self-management standing programme (with advice and support) along with their usual care or to usual care alone. Those in the intervention group will be asked to stand for a minimum of 30 min three times weekly over 20 weeks. Each participant will be followed-up at 20 and 36 weeks post baseline. The primary clinical outcome is motor function, assessed using the Amended Motor Club Assessment. The primary economic endpoint is quality-adjusted life years. The secondary outcomes include measures of explanatory physical impairments, key clinical outcomes, and health–related quality of life. An embedded qualitative component will explore participant’s and carer’s experiences of the standing programme.DiscussionThis is the first large scale multi-centre trial to assess the clinical and cost effectiveness of a home based standing frame programme for people who are severely impaired by MS. If demonstrated to be effective and cost-effective, we will use this evidence to develop recommendations for a health service delivery model which could be implemented across the United Kingdom.Trial registrationISRCTN69614598Date of registration3.2.16 (retrospectively registered)

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The Incidence of Pressure Ulcers in People with Multiple Sclerosis and Persons Responsible for their Management

Cited by 6 publications

References 19 publications

<p>An interprofessional approach to pressure ulcer prevention: a knowledge and attitudes evaluation</p>

<p>An interprofessional approach to pressure ulcer prevention: a knowledge and attitudes evaluation</p>

Development of a Web-Based Monitoring System for Power Tilt-in-Space Wheelchairs: Formative Evaluation

Standing up in multiple sclerosis (SUMS): protocol for a multi-centre randomised controlled trial evaluating the clinical and cost effectiveness of a home-based self-management standing frame programme in people with progressive multiple sclerosis

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