title: A pilot study to evaluate the role of the Spinal Cord Impairment Pressure Ulcer Monitoring Tool (SCI-PUMT) in clinical decisions for pressure ulcer treatment.
abstract: The Spinal Cord Impairment Pressure Ulcer Monitoring Tool (SCI-PUMT) was designed to assess pressure ulcer (PrU) healing in the spinal cord impaired (SCI) population. The tool contains 7 variables: wound surface area, depth, edges, tunneling, undermining, exudate type, and necrotic tissue amount. A 2-phased, quantitative pilot study based on the Theory of Reasoned Action and Theory of Planned Behavior was conducted at a large SCI/Disorders Center in the Department of Veterans Affairs (VA). In the first phase of the study, a convenience sample of 5 physicians, 3 advanced practice registered nurses, and 3 certified wound care nurses (CWCN) was surveyed using a 2-part questionnaire to assess use of the SCI-PUMT instrument, its anticipated improvement in PrU assessment, and intent to use the SCI-PUMT in clinical practice. Attitudes, subjective norms, perceived behavioral controls, and barriers related to the intent to use the SCI-PUMT were evaluated using a 5-point Likert scale (range: 1= extremely likely, 5 = extremely unlikely). In the second phase of the study, the electronic health records (EHR) of 24 veterans (with 30 PrUs) who had at least 2 completed SCI-PUMT scores during a 4-week period were used to evaluate whether an association existed between magnitudes of change of total SCI-PUMT scores and ordered changes in PrU treatment. The overall mean score for intent to use SCI-PUMT was 1.80 (SD 0.75). The least favorable scores were for convenience and motivation to use the SCI-PUMT. Analysis of EHR data showed no significant difference in magnitudes of change in the SCI-PUMT score and changes in PrU treatment recommendations made by the CWCNs. The significance was not affected regardless of an increase or no change in the score (χ2 with 1 degree of freedom = 1.158, P = 0.282) or for a decrease in the score (χ2 with 1 degree of freedom = 0.5, P = 0.478). In this pilot study, the expressed intent to use the SCI-PUMT in making clinical decisions was generally positive but reservations remain. Additional research is being conducted to determine the barriers and facilitators to SCI-PUMT implementation. The SCI-PUMT was the first tool found to be valid, reliable, and sensitive to assess PrU healing in persons with SCI, and studies to examine the prospective validity of using this instrument on ulcer treatment decisions and outcomes are warranted.
authors.affiliation: HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), Tampa, FL; and and Tampa VA Research and Education Foundation, Inc, Tampa, FL; email: Susan.Thomason@va.gov.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Thomason
authors.affiliation: Capstone College of Nursing, Tuscaloosa, AL.
authors.forename: Barbara Ann
authors.initials: BA
authors.lastname: Graves
authors.affiliation: SCI/Rehabilitation and Program Director, Wound Specialist Program & SCI Homecare, James A. Haley Veterans Hospital, Tampa, FL.
authors.forename: Linda
authors.initials: L
authors.lastname: Madaris
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D003668:Pressure Ulcer / Q000534:rehabilitation* / Q000628:therapy; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications / Q000534:rehabilitation / Q000628:therapy*; D014481:United States; D014945:Wound Healing