Preventing recurrent pressure ulcers in veterans with spinal cord injury: impact of a structured education and follow-up intervention.
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.
Rintala
Diana H
DH
Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA. drintala@bcm.tmc.edu
Garber
Susan L
SL
Friedman
Jeffrey D
JD
Holmes
Sally Ann
SA
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*