Therapists' Roles in Pressure Ulcer Management in Persons With Spinal Cord Injury

Abstract

Background: Among veterans with spinal cord injury (SCI), severe pressure ulcers (PrU) are treated by interdisciplinary rehabilitation teams in SCI units. Method: Cross-sectional survey administered to therapists attending a conference of the Therapy Leadership Council in SCI. Participants: Respondents included physical therapists (PTs; n 5 24) and occupational therapists (OTs; n 5 15). Main Outcome Measurements: Wound care practices as indicated by 75% or more of participants as ''usual practice.'' Results: In general, therapist involvement with wound care was initiated by physician order (eg, electrical stimulation) or postsurgery protocols. ''Usual practice'' after tissue healing included progressive range of motion; initial remobilization (first sitting after wound healing); progression of sitting time including assessment of skin tolerance; instruction in pressure relief maneuvers/techniques; and instruction in safe transfers. Practices in prevention of a new ulcer included education and evaluation of seating posture/ positioning. Conclusions: Results indicate that centers may delegate responsibilities for management of ulcers differentially by discipline. A limitation was that we were unable to determine whether these centers were the same or different for OT and PT respondents. Although sample size was small and some sites had multiple respondents, the survey showed a growing role for OTs and PTs in PrU treatment. Because 75% of each discipline reported that there were usual practices, including patient education and remobilization protocols, this area requires further study to determine the clinical outcomes in terms of preventing PrUs and recurrence.

An audit of the physiotherapy management of paraplegic patients with sacral pressure sores

“…A small percentage (38%) of the study sample reported being involved in direct wound care management. This differs to Guihan et al (2009)'s findings where they reported more than 75% of the physiotherapists to be involved in direct wound care. Eighteen percent of the respondents from this study used electrotherapy to manage pressure sores and the modalities most commonly used were ultrasound and laser.…”

“…Interventions that were carried out by 70% or more of the physiotherapists were taken to represent "common practice", which is fairly similar to the benchmark of 75 % which was set as usual practice in Guihan et al (2009)'s study. Seventy percent of the physiotherapists indicated carrying out the following interventions when the patient was in bed: upper limb muscle strengthening, lower limb passive movements, positioning into prone and side lying as well as upper limb passive movements and passive stretching.…”

“…Physiotherapists in Guihan et al (2009)'s study were routinely involved in the prevention of new pressure sores by means of pressure sore education. Eight percent of this sample indicated being involved in group therapy and education, however, this aspect was not fully explored in this study and that could possibly explain the small percentage.…”

Lifestyle risk factors for pressure ulcers in community-based patients with spinal cord injuries in Japan

“…The reliability of the SCIPUS and Braden scales for the prediction of SCI risk has been demonstrated; however, their validity has not been reported. 12 The interview questionnaire included questions on sociodemographic status and lifestyle factors, the latter were selected based on previous studies and our clinical experience [5][6][7][8]10,13 and are shown in Table 1. On-thewheelchair IP measurements of both groups were done using the FSA (Force sensing Array) Pressure Mapping System (Vista Medical Ltd, Manitoba, Canada); peak pressure, contact area and average pressure were calculated.…”

“…7 In the clinical setting, we contribute to PU prevention by providing pressure redistribution on the wheelchair, instructing patients in pressure relief practices and evaluating activities that include the risk of PUs. 8 Therefore, knowing which aspects of daily living strongly influence the risk of PU occurrence would help guide prevention strategies. Characterization of the relationship between interface pressure (IP) measurements on the wheelchair and PUs is also essential, 9 as IP may be useful for the investigating seat pressure and daily living-related risk factors for PUs in patients with SCI.…”