Daily Living Context and Pressure Sores in Consumers with Spinal Cord Injuries
The research team of this study completed a qualitative investigation of the daily lifestyle influences on the development of pressure ulcers in adults with SCI (Clark et al., 2006). The results of this research contributed heavily to the intervention that is the focus of the current Lifestyle Redesign® for Pressure Ulcer Prevention in SCI study.
In this preliminary investigation the team sought to complement existing knowledge of general predictive relationships by examining the complex determinants of ulcers within holistically construed individual life contexts. The research participants were 19 adults with SCI and one with transverse myelitis who were recruited at the Rancho Los Amigos National Rehabilitation Center’s (RLANRC, located in Downey, CA) Pressure Ulcer Management Service (PUMS). PUMS provides services to several hundred adults with spinal cord injury each year, with the majority having Stage 3 (subcutaneous tissue exposed) or Stage 4 (muscle/bone exposed) pressure ulcers. All study participants were English or Spanish speaking, were at least one year post injury/disease onset, and had received prior treatment at RLANRC for at least one serious (Stage 3 or Stage 4) pressure ulcer (for the purpose of contrast, one previously ulcer-free participant was included in the sample).
Based on the research findings, the study team produced an online consumer guide to effective prevention (www. pressureulcerprevention.com), a manual in CD-ROM format for use by healthcare professionals, and a preventive intervention manual for use by occupational therapists (Lifestyle Redesign for Pressure Ulcer Prevention [LR-PUP] Manual). The intervention manual forms the basis of the LR treatment program that will be tested in the current Lifestyle Redesign® for Pressure Ulcer Prevention in SCI study.
In addition to the above products, a series of theoretical models were formulated to describe process events that lead to pressure ulcers within the daily lives of adults with SCI (Clark et al., 2006). In general, the results underscored the notion that within everyday settings, multiple, complexly interrelated circumstances contribute to the development of pressure ulcers and/or their recurrence. Apart from being complex, the daily lifestyle phenomena that surround pressure ulcers are also highly individualized. In addition to the publication by Clark et al. (2006), data-based articles on individuals’ responses to the initial emergence of a low grade ulcer (Dunn, Carlson, Jackson, & Clark, 2008) and on the need to incorporate daily lifestyle concerns into a risk assessment tool (Seip, Carlson, Jackson, & Clark, 2008) have been recently submitted for publication.
The findings of the study have important implications for clinical practice. For example, the widespread individual differences that we observed suggest that healthcare practitioners can best foster prevention by helping consumers identify and implement lifestyle changes that are considered to be personally feasible within their uniquely experienced set of circumstances. Thus, an optimal intervention should not only incorporate standard prevention techniques such as skin checks or pressure reliefs, but also, based on a given consumer’s personally unique profile, direct attention to further concerns such as self-advocacy skills, stress management, or the ability to identify an optimal balance between living a full life and avoiding activity-related ulcers.