title: Use of behavioral contingencies to promote prevention of recurrent pressure ulcers.
abstract: OBJECTIVE
  To determine effectiveness of an intervention using monetary rewards as a consequence for preventing or reducing severity of pressure ulcers in spinal cord injury (SCI) patients with a history of chronic, recurrent ulcers.
  
  
  METHODS
  Multiple baseline analysis across subjects (time-lagged control), comparing severity of pressure ulcers and treatment costs during baseline and intervention.
  
  
  METHODS
  Outpatient wound-care clinic of private, nonprofit specialty hospital.
  
  
  METHODS
  Nine adults (all with paraplegia) with a history of hospitalizations for treatment of pressure ulcers.
  
  
  METHODS
  In study 1, participants (n=6) undertook (1) a comprehensive self-care plan, (2) had a graduated schedule of visits with an advanced practice nurse, and (3) received monetary rewards for successfully preventing serious ulcers. In study 2, participants (n=3) undertook interventions 1 and 2, but monetary rewards were in staged phases so a component analysis could compare the effectiveness of visits alone to visits plus monetary rewards.
  
  
  METHODS
  Severity of pressure ulcers measured with the Pressure Ulcer Scale for Healing (PUSH Tool 3.0); and direct costs of treatment and preventive care for pressure ulcers.
  
  
  RESULTS
  In study 1, severity of pressure ulcers-and their related treatment costs-decreased for the 6 participants. Maintenance of effects postintervention was highly variable, with only 3 participants showing long-term improvements. In study 2, for 2 participants, visits alone did not reduce pressure ulcer severity, but visits plus payments did effectively reduce ulcer severity, indicating improved prevention behaviors.
  
  
  CONCLUSIONS
  Findings support the assumption that pressure ulcers may recur among some individuals because there are insufficient positive consequences for effective prevention.
authors.affiliation: Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA. mike_jones@shepherd.org
authors.forename: Michael L
authors.initials: ML
authors.lastname: Jones
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Mathewson
authors.forename: Vincent K
authors.initials: VK
authors.lastname: Adkins
authors.forename: Teodoro
authors.initials: T
authors.lastname: Ayllon
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008134:Long-Term Care / Q000191:economics / Q000379:methods; D008297:Male; D003668:Pressure Ulcer / Q000191:economics / Q000209:etiology* / Q000517:prevention & control*; D055502:Secondary Prevention; D013119:Spinal Cord Injuries / Q000150:complications* / Q000191:economics / Q000534:rehabilitation; D016896:Treatment Outcome