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Evidence Supporting Pressure Ulcer Prevention Strategies

What is the evidence for pressure ulcer education for prevention of pressure ulcers among individuals with SCI?

There is level 2 evidence that providing enhanced pressure ulcer prevention education is effective at helping individuals with SCI gain and retain this knowledge. 

There is level 1 evidence that providing enhanced pressure ulcer education and structured follow-up is effective in reducing recurrence of pressure ulcers especially in those individuals with no previous history of pressure ulcer surgery.

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Structured pressure ulcer prevention education, helps individuals post SCI gain and retain knowledge of pressure ulcer prevention practices.

Research is needed to determine the specific educational needs of individuals with SCI required to reduce the risk of pressure ulcer formation.

More research is needed to determine if pressure ulcer prevention education results in a reduction of pressure ulcers post SCI.

What is the evidence for seating assessments for pressure ulcer prevention in individuals with SCI?
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What is the evidence for cushions for pressure ulcer prevention in individuals with SCI?

There is level 3 evidence that various cushions or seating systems (e.g. dynamic versus static) are associated with potentially beneficial reduction in seating interface pressure or pressure ulcer risk factors like skin temperature.


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No one cushion is suitable for all individuals with SCI.

Cushion selection should be based on a combination of pressure mapping results, clinical knowledge of prescriber, individual characteristics and preference.

More research is needed to see if decreasing ischial pressures or decreasing risk factors such as skin temperature via the use of specialty cushions will help prevent pressure ulcers post SCI.

What is the evidence supporting the use of pressure mapping for pressure ulcer prevention in individuals with SCI?

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What is the evidence supporting the use of pressure relief practices as a preventative measure for pressure ulcers in individuals with SCI?

There is level 3 evidence that 1-2 minutes of pressure relief must be sustained to raise tissue oxygen to unloaded levels.

There is level 4 evidence to support position changes to reduce pressure at the ischial tuberosities.

65° of tilt or forward leaning of >45° both showed significant reduction in pressure.

 

The type and duration of pressure relief by position changing must be individualized post SCI using pressure mapping or similar techniques.

 

More research is needed to see if decreasing ischial pressures and/or increasing blood flow to tissues using weight shifting techniques will help prevent pressure ulcers post SCI.

 

For most individuals with SCI, a pushup/vertical lift of 15-30 seconds is unlikely to be sufficient to allow for complete pressure relief.

What is the evidence supporting the use of electrical stimulation for pressure ulcer prevention in individuals with SCI?

There is limited level 4 evidence that electrical stimulation decreases ischial pressures post SCI.

There is level 4 evidence that electrical stimulation may increase blood flow at sacral and gluteal areas post SCI.

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Electrical stimulation may decrease ischial pressures.

Electrical stimulation may increase blood flow to tissues.

More research is needed to see if decreasing ischial pressures and/or increasing blood flow to tissues will help prevent pressure ulcers post SCI.