REPORTED PRESSURE ULCER PREVENTION AND MANAGEMENT-TECHNIQUES BY PERSONS WITH SPINAL-CORD INJURY

Objective: The purpose of this study was to identify factors that resu lted in severe pressure ulcers in a community-based sample of 23 perso ns with spinal cord injury (SCI). Design: A correlational design was u sed. Subjects: Twenty men and three women, 57% with tetraplegia and 43 % with paraplegia, participated. Adult participants with an ulcer of 1 2 weeks' duration or less were recruited from the plastic surgery clin ic of a regional SCI center. Measures: A structured survey assessed de mographic, SCI, and ulcer characteristics; detection method; immediacy and appropriateness of action; time from detection to clinic visit; n umber of prior ulcers; and knowledge and practice of ulcer prevention techniques. Ulcer characteristics (ie, location, size, and stage) were assessed by examination and compared with participants' descriptions of their ulcers. Results: Severe ulcers and ulcers that progressed in severity after initial detection were less accurately described by par ticipants. Individuals who waited longer to come to the clinic present ed with more severe ulcers. Taking immediate or appropriate action whe n an ulcer was detected was related to reported performance of more pr eventive behaviors. Contrary to expectation, immediacy and appropriate ness of action, and knowledge and practice of preventive behaviors wer e unrelated to severity, progression of severity, and time from detect ion to the clinic visit. The findings suggest that educational program s should emphasize more strongly immediate visits to a physician upon detection of an ulcer. Furthermore, such educational models should be assessed for their effectiveness in reducing ulcers and preventing pro gression in severity once persons with SCI return to the community. (C ) 1996 by the American Congress of Rehabilitation Medicine and the Ame rican Academy of Physical Medicine and Rehabilitation.