Interdisciplinary Pressure Management & Mobility Program as an Alternative to Usual Care: A Pilot Study (WOUND)

People with spinal cord injuries posses many factors that increase their risk of developing pressure ulcers.

Not surprisingly, approximately 82% of persons with spinal cord injury (SCI) will experience a pressure ulcer at sometime during their life.

Earlier guidelines for the assessment and treatment of pressure ulcers produced by RNAO in 20027 recommended that “a client who has a pressure ulcer on a seating surface should avoid sitting.” Unfortunately, this recommendation has fueled the long standing view that people with pressure ulcers should stop using their wheelchairs and return to bed.

The strength of evidence assigned for this recommendation was Level=C reflecting the paucity of research evidence to support this common practice. Not only do the benefits of bed rest on healing remain to be demonstrated, there is mounting evidence that bed rest can be harmful to a person’s overall health and well being. Bed rest has been shown to be strongly associated with complications in most body systems including respiratory, cardiovascular, musculoskeletal, cerebrovascular, gastrointestinal, and genital-urinary. Psychosocial complications and cognitive impacts are also well documented.

Without evidence to dispel the myth that “bed rest is best” it will be difficult to change practice and avoid many of the secondary complications.

This study is a pilot study to

1. Determine whether pressure ulcers heal faster in individuals with SCI who receive an individualized community-based, pressure management and mobility program compared to a similar group assigned to usual care (bed rest).

2. Determine the strength of the association between the intervention (pressure/mobility or bedrest) and wound healing, motor performance/independence and quality of life while adjusting for motivation to regain independence, degree of caregiver burden, and compliance with the intervention.

3. Determine whether individuals with SCI who participate in a pressure/mobility management program experience fewer secondary complications than those who do not participate.

4. Determine the cost-effectiveness of providing a time-efficient, pressure management and mobility program compared to bed rest.