Difficulty in Identifying Factors Responsible for Pressure Ulcer Healing in Veterans With Spinal Cord Injury

Marylou Guihan*, Min Woong Sohn, William A. Bauman, Ann M. Spungen, Gail M. Powell-Cope, Susan S. Thomason, Joseph F. Collins, Barbara M. Bates-Jensen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Objective To identify characteristics associated with pressure ulcer (PrU) healing for individuals with spinal cord injury (SCI). Design Secondary analysis of a large clinical trial's data for healing PrUs in individuals with SCI; prospective Delphi process was conducted with SCI and/or PrU experts. Setting Spinal cord injury centers. Participants There were 629 screening and 162 treatment participants (N=791); 185 SCI clinicians/national PrU/wound care experts participated in the Delphi process. Interventions None. Main Outcome Measure PrU healing of 50% and 100% at weeks 4 and 12. Results Poisson regression models using the top Delphi-recommended factors found that only ulcer stage consistently predicted 50% and 100% healing at weeks 4 and 12. Additionally, ischial/perineal location was associated with 33% higher likelihood of 50% healing at week 4. Patient noncompliance with treatment recommendations, the top-ranked Delphi factor, did not predict healing at week 4 or 12. Expanded models found that at week 4, baseline PrU size, PrU stage IV, PrU pain, and American Spinal Injury Association grade A significantly predicted 100% healing, while at week 12, only PrU stage (IV) significantly predicted 100% healing. Significant predictors of 50% healing at week 4 included baseline PrU size, stage, ischial/perianal location body mass index >30kg/m2, foul odor, and signs of infection. At week 12, PrU duration, paraplegia predicted 50% healing. SCI center identifiers consistently showed 2- to 5-fold variation in predicting 50% PrU healing at weeks 4 and 12. Conclusions Delphi panel-recommended factors (eg, patient compliance) did not predict PrU healing. Reducing center-level variability in wound healing by learning from best practices should be a health system goal. PrU healing in SCI is still poorly understood, and future studies should focus on as yet unidentified or underappreciated factors.

Original languageEnglish (US)
Pages (from-to)2085-2094.e1
JournalArchives of physical medicine and rehabilitation
Volume97
Issue number12
DOIs
StatePublished - Dec 1 2016

Keywords

  • Pressure ulcer
  • Rehabilitation
  • Spinal cord injuries
  • Veterans

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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