title: Preventing recurrent pressure ulcers in veterans with spinal cord injury: impact of a structured education and follow-up intervention.
abstract: OBJECTIVE
  To test the hypothesis that enhanced education and structured follow-up after pressure ulcer surgery will result in fewer recurrences.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Veterans Affairs medical center.
  
  
  METHODS
  Forty-nine veteran men with spinal cord injury or dysfunction were approached on admission for pressure ulcer surgery. Five never had surgery, 2 refused to participate, and one withdrew. Forty-one were randomized into 3 groups. Three participants' ulcers did not heal, so follow-up could not begin.
  
  
  METHODS
  Group 1 received individualized pressure ulcer education and monthly structured telephone follow-up (n=20); group 2 received monthly mail or telephone follow-up without educational content (n=11); and group 3 received quarterly mail or telephone follow-up without educational content (n=10). Follow-up continued until recurrence, death, or 24 months.
  
  
  METHODS
  Time to pressure ulcer recurrence.
  
  
  RESULTS
  Group 1 had a longer average time to ulcer recurrence or end of study than groups 2 and 3 (19.6 mo, 10.1 mo, 10.3 mo; P=.002) and had a smaller rate of recurrence (33%, 60%, 90%; P=.007). Survival analysis confirmed these findings (P=.009).
  
  
  CONCLUSIONS
  Individualized education and structured monthly contacts may be effective in reducing the frequency of or delaying pressure ulcer recurrence after surgical repair of an ulcer.
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA. drintala@bcm.tmc.edu
authors.forename: Diana H
authors.initials: DH
authors.lastname: Rintala
authors.forename: Susan L
authors.initials: SL
authors.lastname: Garber
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Friedman
authors.forename: Sally Ann
authors.initials: SA
authors.lastname: Holmes
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D003668:Pressure Ulcer / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D012307:Risk Factors; D055502:Secondary Prevention; D013119:Spinal Cord Injuries / Q000150:complications*; D016019:Survival Analysis; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*