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An exploratory study of pressure ulcers after spinal cord injury: Relationship to protective behaviors and risk factors☆,☆☆

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Abstract

Krause JS, Vines CL, Farley TL, Sniezek J, Coker J. An exploratory study of pressure ulcers after spinal cord injury: relationship to protective behaviors and risk factors. Arch Phys Med Rehabil 2001;82:107-13. Objectives: To identify protective behaviors and risk factors associated with the development of pressure ulcers (PUs) after spinal cord injury (SCI). Design: A cross-sectional study to evaluate the relationship between protective behaviors and risk factors and 3 PU outcomes: a current PU, PUs within the past year, and ever hospitalized for a PU. Logistic regression was then used to identify the variables most strongly associated with PU outcomes. Setting: Data were collected by case managers employed by the Arkansas Spinal Cord Commission, an agency that provides services to persons with SCI. Participants: A total of 650 of 991 eligible individuals with SCI from a statewide population-based SCI registry participated. All ambulatory participants were eliminated, leaving 560 patients. Average age of the respondents was 27.2 years at injury (median age, 25yr) and 43.6 years at the time of the survey (median age, 42yr). Main Outcome Measures: A 200-item interview was developed to measure a broad range of outcomes associated with SCI (including secondary conditions such as PUs), as well as risk and protective behaviors related to these outcomes. Results: Several characteristics and behaviors were related to PU outcomes. Being underweight (odds ratio [OR] = 2.18), having used medications to treat pain (OR = 1.33) or spasticity (OR = 1.31), having smoked at least 100 cigarettes over a lifetime (OR = 1.31), and being a current smoker (OR = 1.21) were associated with having a PU in the past year. Having completed a college degree (OR = 0.23), being married (OR = 0.49), and being currently employed (OR = 0.54) were associated with a lower risk of having a PU in the past year. Being underweight (OR = 1.94), having a history of incarceration (OR = 1.78), having attempted suicide (OR = 1.71), and reporting alcohol or drug treatment (OR = 1.65) were associated with having been hospitalized for a PU since injury. This study was unable to evaluate the efficacy of traditional health maintenance or protective behaviors for PUs, such as weight shifts or skin checks. Conclusions: PUs are least likely to occur among individuals who maintain normal weight, return to a work and family role, and who do not have a history of tobacco use, suicidal behaviors, or self-reported incarcerations, or alcohol or drug abuse. Additional research is needed to identify better the risk factors for the occurrence of PUs. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Purpose

This study sought to identify protective behaviors and risk factors associated with the development of PUs among persons with SCI living in the community. Three PU outcomes were investigated: current PUs, at least 1 PU within the past year, or hospitalization because of a PU. Protective and risk factors and PU outcomes were selected from a 200-item survey from a population study of secondary conditions and SCI. The variables selected reflect either protective behaviors, risk behaviors, or proxy

Participants

All participants were drawn from the Arkansas Spinal Cord Commission (ASCC) registry. Since 1977, the ASCC has maintained a registry for persons with spinal cord disability; it is used primarily to provide case management services. To be listed in the registry, participants must have a spinal cord disability and exhibit 3 of 4 of the following characteristics: lack of normal motor control, lack of normal sensation, lack of normal bladder function, and/or lack of normal bowel function.

Participant characteristics

The majority of participants (76%) was white. About 22% were black; other minorities comprised the remaining 2%. By gender and race/ethnicity, 60.2% were white men, 20% were white women, 15.9% were minority men, and 3.9% were minority women. At the time of the survey, respondents ranged from 20 to 86 years, with a mean age of 43.6 (median, 42yr). The average age at injury was 27.2 years (median, 25yr). The mean number of years since injury was 14.5 (median, 13yr), with just under half (43.5%)

Discussion

The current study attempted to identify protective and risk factors for the development of PUs after SCI among participants from a population-based registry. The results identified several personal and behavioral characteristics associated with PU outcomes. Of the 3 outcomes measured, hospitalization for a PU was the most strongly associated with the protective behaviors and risk factors.

Conclusion

Future research would benefit from a more detailed assessment of recent and current PU history, including attention to the number and severity of sores, as well as cause. Linking risk factors and protective behaviors to cause may be important, because some PUs result from negligent skin care, whereas others develop after a fall, burn, or equipment failure. Similarly, some PUs may result from barriers to treatment, such as a lack of assistance, poor access to health care, or reluctance to take

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No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

☆☆

Reprint requests to J. Stuart Krause, PhD, CRI, Shepherd Center, 2020 Peachtree Rd, Atlanta, GA 30309, e-mail: [email protected].

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Copyright © 2001 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.