Adherence to ‘pressure-relief’ regimen for pressure ulcer (PrU) prevention in spinal cord injury (SCI)

Objectives: 1) To explore whether people with SCI follow advice on ‘pressure-relief’; 2) to evaluate views on performing ‘pressure-relief’ for PrU prevention and identify barriers to following pressure-relief advice in SCI.
Method: Mixed methods pilot study. Wheelchair-users with SCI were recruited. A questionnaire was used to assess concordance to pressure-relief advice, perceived necessity, concerns and barriers to performing pressure-relief and perceptions of PrU. To explore patients’ views in-depth, semi-structured telephone interviews were carried out.
Results: 31 SCI aged 44.7yr±14.4 were surveyed. Average duration of injury was 16.7years±16.2, 58% experienced a PrU, 94% PrU were gluteal/sacral. Although most respondents (84%) performed pressure-relief daily, only 22% performed the amount recommended. Poor concordance to advice is illustrated by adherence score, 25±4.6 (maximum 35). Perceived Necessity score was low (1.7±0.6); Concerns about pressure-relief were high (4.1±0.8) indicating patients typically had concerns about potential negative events of pressure-relief. Practical barriers were also frequently reported (score was 3.5±0.7). Despite this, PrU were viewed as serious threatening as shown by the brief IPQ score of 64±9.3 (maximum 80). Five individuals participated in interviews. Analysis identified 4 themes: lack of knowledge and support, unawareness of impact of PrU soon after SCI, perceptions that pressure-relief is unnecessary, and practical barriers in tetraplegia.
Conclusion: We found poor concordance with pressure-relief advice in SCI. Lack of knowledge, doubts in the necessity of pressure-relief, concerns about the negative effects and practical barriers of performing pressure-relief could contribute. Future early education and tailored interventions are warranted for PrU prevention in this population.