title: Ultraviolet-C irradiation in the management of pressure ulcers in people with spinal cord injury: a randomized, placebo-controlled trial.
abstract: OBJECTIVE
  To compare the effects of ultraviolet-C (UVC) with placebo-UVC on pressure ulcer healing in individuals with spinal cord injury (SCI).
  
  
  METHODS
  Double-blind randomized trial with stratification for ulcer location to buttock or lower extremity. Subjects were followed up for 1 year postintervention.
  
  
  METHODS
  Rehabilitation institution.
  
  
  METHODS
  Adult inpatients and outpatients (N=43) with SCI and stage 2 to 4 pressure ulcers (n=58).
  
  
  METHODS
  Ulcers and periwound skin were irradiated 3 times per week using UVC or placebo-UVC. The endpoint was wound closure or hospital discharge without closure.
  
  
  METHODS
  Primary outcome was weekly percent area relative to baseline. Secondary outcomes were mean percent area change between consecutive weeks, surface appearance, weeks to closure, and impact on quality of life and wound status postintervention.
  
  
  RESULTS
  Groups were similar at baseline for all demographic characteristics except ulcer duration (P=.02). Groups were similar when healing was compared overall. Subgroup analysis showed that the percent area relative to baseline for stage 2 buttock ulcers was significantly smaller in the group receiving UVC compared with placebo at weeks 3, 5, and 7. During weeks 1 through 8, these ulcers were 26% to 76% of baseline area using UVC versus 111% to 180% for placebo (achieved significant level [ASL], .03-.08; effect size, 0.5-0.8). Groups were similar in the percent area relative to baseline for stage 2 lower extremity ulcers. Group mean percent area change between consecutive weeks for all stage 2 ulcers was 36.6% with the use of UVC and 5.8% for placebo (ASL=.09). There were no group differences in the percent area relative to baseline and the mean percent area change between consecutive weeks for stage 3 to 4 ulcers. Groups were similar for all other secondary outcomes.
  
  
  CONCLUSIONS
  UVC is beneficial for stage 2 buttock ulcers. Further studies are warranted using a larger sample size, carefully considered exclusion criteria, and strategies to ensure homogeneity of the groups that are being compared.
authors.affiliation: Department of Physical Therapy, Mount Sinai Hospital, Toronto, Ontario, Canada. e.nussbaum@utoronto.ca
authors.forename: Ethne L
authors.initials: EL
authors.lastname: Nussbaum
authors.forename: Heather
authors.initials: H
authors.lastname: Flett
authors.forename: Sander L
authors.initials: SL
authors.lastname: Hitzig
authors.forename: Colleen
authors.initials: C
authors.lastname: McGillivray
authors.forename: Diane
authors.initials: D
authors.lastname: Leber
authors.forename: Helen
authors.initials: H
authors.lastname: Morris
authors.forename: Fang
authors.initials: F
authors.lastname: Jing
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000209:etiology / Q000473:pathology / Q000532:radiotherapy*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000379:methods*; D014945:Wound Healing / Q000528:radiation effects; D055815:Young Adult