Using telehealth interventions to prevent pressure ulcers in newly injured spinal cord injury patients post-discharge. Results from a pilot study
|Authors:||Porteous, N., & Waghorn, G|
|Publication||International Journal of Technology Assessment in Healthcare|
Spinal cord injuries (SCIs) are rare but catastrophic occurrences. They produce permanent changes in sensory and motor function and physical impairments that restrict mobility, often completely. Although definitive statistics are lacking, studies estimate the incidence of spinal cord injuries to range from 30 to 50 cases per million people. Because of the profound physiological impact of SCIs, those affected are at increased risk for secondary health problems. Pressure sores or ulcers have been identified as one of the most common problems.
The purpose of this study was to determine which of three approaches to care produces the lowest incidence of pressure ulcers, promotes the most effective care of sores that develop, and leads to the fewest hospitalizations in newly injured patients with spinal cord injury after discharge.
The sample included 37 individuals with newly acquired spinal cord injury.
All three groups were surveyed every 2‚Äì3 months about doctor, hospital, and emergency room visits, calls to the Shepherd Center helpline, ulcer occurrences and characteristics, and employment status. Data on participant characteristics were analyzed using the Kruskal-Wallis rank sum test and k-sample chi-square tests for continuous and categorical variables. Outcome data were analyzed using Friedman‚ test to investigate response differences for multiple treatments applied to a series of subjects.
The comparison condition was standard care.
The video group had the greatest number of reported and identified pressure ulcers. Differences in health care utilization between the video and telephone telehealth groups were small. The standard care group reported the lowest number of pressure ulcers and lowest frequency of health care utilization. Substantial differences existed in employment rates before and after injury. The video group had the lowest pre-injury rate of employment and the highest post-injury rate of employment.
Tracking pressure ulcer incidence, particularly stage I sores, is difficult. Self-report is likely to lead to substantial underreporting. Similarly, self-report on health care utilization over extended periods may lead to undercounting of encounters. Telehealth interventions appear to improve ulcer tracking and management of all ulcer occurrences. Video interventions may affect outcomes, such as employment rates, which are not conventionally measured.