Marylou Guihan1, Jennifer Hastings, Susan L Garber. 1. Center for Management of Complex Chronic Care (CMC3) Edwards Hines, Jr. VA Hospital (151-H), 5000 S. 5th Avenue, Hines, IL 60141-3030, USA. Marylou.guihan@va.gov
Abstract
BACKGROUND: Among veterans with spinal cord injury (SCI), severe pressure ulcers (PrU) are treated by interdisciplinary rehabilitation teams in SCI units. METHOD: Cross-sectional survey administered to therapists attending a conference of the Therapy Leadership Council in SCI. PARTICIPANTS: Respondents included physical therapists (PTs; n=24) and occupational therapists (OTs; n=15). MAIN OUTCOME MEASUREMENTS: Wound care practices as indicated by 75% or more of participants as "usual practice". RESULTS: In general, therapist involvement with wound care was initiated by physician order (e.g., electrical stimulation) or postsurgery protocols. "Usual practice" after tissue healing included progressive range of motion; initial remobilization (first sitting after wound healing); progression of sitting time including assessment of skin tolerance; instruction in pressure relief maneuvers/techniques; and instruction in safe transfers. Practices in prevention of a new ulcer included education and evaluation of seating posture/positioning. CONCLUSIONS: Results indicate that centers may delegate responsibilities for management of ulcers differentially by discipline. A limitation was that we were unable to determine whether these centers were the same or different for OT and PT respondents. Although sample size was small and some sites had multiple respondents, the survey showed a growing role for OTs and PTs in PrU treatment. Because 75% of each discipline reported that there were usual practices, including patient education and remobilization protocols, this area requires further study to determine the clinical outcomes in terms of preventing PrUs and recurrence.
BACKGROUND: Among veterans with spinal cord injury (SCI), severe pressure ulcers (PrU) are treated by interdisciplinary rehabilitation teams in SCI units. METHOD: Cross-sectional survey administered to therapists attending a conference of the Therapy Leadership Council in SCI. PARTICIPANTS: Respondents included physical therapists (PTs; n=24) and occupational therapists (OTs; n=15). MAIN OUTCOME MEASUREMENTS: Wound care practices as indicated by 75% or more of participants as "usual practice". RESULTS: In general, therapist involvement with wound care was initiated by physician order (e.g., electrical stimulation) or postsurgery protocols. "Usual practice" after tissue healing included progressive range of motion; initial remobilization (first sitting after wound healing); progression of sitting time including assessment of skin tolerance; instruction in pressure relief maneuvers/techniques; and instruction in safe transfers. Practices in prevention of a new ulcer included education and evaluation of seating posture/positioning. CONCLUSIONS: Results indicate that centers may delegate responsibilities for management of ulcers differentially by discipline. A limitation was that we were unable to determine whether these centers were the same or different for OT and PT respondents. Although sample size was small and some sites had multiple respondents, the survey showed a growing role for OTs and PTs in PrU treatment. Because 75% of each discipline reported that there were usual practices, including patient education and remobilization protocols, this area requires further study to determine the clinical outcomes in terms of preventing PrUs and recurrence.
Authors: Marylou Guihan; Susan L Garber; Charles H Bombardier; Barry Goldstein; Sally A Holmes; Lishan Cao Journal: J Spinal Cord Med Date: 2008 Impact factor: 1.985
Authors: Marylou Guihan; Susan L Garber; Charles H Bombardier; Ramon Durazo-Arizu; Barry Goldstein; Sally Ann Holmes Journal: Arch Phys Med Rehabil Date: 2007-07 Impact factor: 3.966
Authors: Brianna M Goodwin; Christine M Olney; John E Ferguson; Andrew H Hansen; Byron Eddy; Gary Goldish; Melissa M Morrow; Tamara L Vos-Draper Journal: Assist Technol Date: 2021-03-11