Comparing multicomponent interventions to improve skin care behaviors and prevent recurrence in veterans hospitalized for severe pressure ulcers.
OBJECTIVE
To compare a multicomponent motivational interviewing (MI)/self-management (SM) intervention with a multicomponent education intervention to improve skin-protective behaviors and prevent skin worsening in veterans with spinal cord injury (SCI) hospitalized for severe pressure ulcers (PrUs).


METHODS
Single-blinded, prospective, randomized controlled trial.


METHODS
Six Veterans Affairs SCI centers.


METHODS
Veterans admitted for a severe (stage III/IV) PrU were followed up to 6 months postdischarge.


METHODS
Telephone-based individual MI counseling plus SM skills group (SM+MI; n=71) versus an active control group of telephone-based individual educational counseling plus group education (n=72).


METHODS
Self-reported skin-protective behaviors, objective skin worsening.


RESULTS
Intention-to-treat analyses found nonsignificant increases in skin behaviors in the SM+MI versus education control intervention arms at 3 and 6 months. The difference in behaviors used between SM+MI and education control intervention participants was 4.6% (95% confidence interval [CI], -11.3 to 2.7) (0-3mo) and 3.0% (95% CI, -8.7 to 3.9) (0-6mo). High rates of skin worsening were observed (n=74, 51.7%), usually within 3 months postdischarge and most frequently within the month postdischarge. Skin worsening, skin-related visits, and readmissions did not differ by study arm. Study limitations are presented.


CONCLUSIONS
For persons with chronic SCI and severe PrUs, complicated by multiple comorbidities, a primary focus on improving patient behavior is likely insufficient to address the complex problem of PrUs in SCI. More health care systems-level changes such as collaborative care may be needed to reduce PrU recurrence, especially in this era in which many people are discharged from the hospital unhealed or with little sitting tolerance.
Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Jr. VA Hospital, Hines, IL; Edward Hines, Jr. VA Hospital, Hines, IL; Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address: Marylou.guihan@va.gov.
Marylou
M
Guihan
Division of Clinical and Neuropsychology, University of Washington, Seattle, WA.
Charles H
CH
Bombardier
Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
Dawn M
DM
Ehde
Edward Hines, Jr. VA Hospital, Hines, IL.
Lauren M
LM
Rapacki
Edward Hines, Jr. VA Hospital, Hines, IL.
Thea J
TJ
Rogers
SCI QUERI, UCLA School of Nursing, Los Angeles, CA.
Barbara
B
Bates-Jensen
St. Louis VA Medical Center, St. Louis, MO.
Florian P
FP
Thomas
Edward Hines, Jr. VA Hospital, Hines, IL.
Rama
R
Parachuri
Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX.
Sally A
SA
Holmes
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003376:Counseling / Q000379:methods*; D005260:Female; D006782:Hospitals, Special; D006801:Humans; D033182:Intention; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D003668:Pressure Ulcer / Q000517:prevention & control*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D014481:United States; D014493:United States Department of Veterans Affairs
Health behavior, patient compliance; Outcome assessment (health care); Rehabilitation; Self care