title: Systematic review of behavioral and educational interventions to prevent pressure ulcers in adults with spinal cord injury.
abstract: OBJECTIVE
  To investigate the efficacy of behavioral or educational interventions in preventing pressure ulcers in community-dwelling adults with spinal cord injury (SCI).
  
  
  METHODS
  Cochrane, Clinical Trials, PubMed, and Web of Science were searched in June 2016. The search combined related terms for pressure ulcers, spinal cord injury, and behavioral intervention. Each database was searched from its inception with no restrictions on year of publication.
  
  
  METHODS
  Inclusion criteria required that articles were (a) published in a peer-reviewed journal in English, (b) evaluated a behavioral or educational intervention for pressure ulcer prevention, (c) included community-dwelling adult participants aged 18 years and older with SCI, (d) measured pressure ulcer occurrence, recurrence, or skin breakdown as an outcome, and (e) had a minimum of 10 participants. All study designs were considered. Two reviewers independently screened titles and abstracts. Extracted information included study design, sample size, description of the intervention and control condition, pressure ulcer outcome measures, and corresponding results.
  
  
  RESULTS
  The search strategy yielded 444 unique articles of which five met inclusion criteria. Three were randomized trials and two were quasi-experimental designs. A total of 513 participants were represented. The method of pressure ulcer or skin breakdown measurement varied widely among studies. Results on pressure ulcer outcomes were null in all studies. Considerable methodological problems with recruitment, intervention fidelity, and participant adherence were reported.
  
  
  CONCLUSIONS
  At present, there is no positive evidence to support the efficacy of behavioral or educational interventions in preventing pressure ulcer occurrence in adults with SCI.
authors.affiliation: 1 Mrs TH Chan Division of Occupational Science and Occupational Therapy, University of Southern California, USA.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Cogan
authors.affiliation: 1 Mrs TH Chan Division of Occupational Science and Occupational Therapy, University of Southern California, USA.
authors.forename: Jeanine
authors.initials: J
authors.lastname: Blanchard
authors.affiliation: 2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Garber
authors.affiliation: 1 Mrs TH Chan Division of Occupational Science and Occupational Therapy, University of Southern California, USA.
authors.forename: Cheryl Lp
authors.initials: CL
authors.lastname: Vigen
authors.affiliation: 1 Mrs TH Chan Division of Occupational Science and Occupational Therapy, University of Southern California, USA.
authors.forename: Mike
authors.initials: M
authors.lastname: Carlson
authors.affiliation: 1 Mrs TH Chan Division of Occupational Science and Occupational Therapy, University of Southern California, USA.
authors.forename: Florence A
authors.initials: FA
authors.lastname: Clark
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods; D005260:Female; D006801:Humans; D057187:Independent Living; D008297:Male; D010353:Patient Education as Topic / Q000379:methods; D003668:Pressure Ulcer / Q000209:etiology / Q000517:prevention & control* / Q000534:rehabilitation; D011322:Primary Prevention / Q000193:education*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D017592:Skin Care / Q000379:methods; D013119:Spinal Cord Injuries / Q000150:complications* / Q000175:diagnosis; D016896:Treatment Outcome
keywords: Behavioral intervention; education; pressure ulcer; prevention; spinal cord injuries