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Effect of Behavioural Contingencies on Pressure Ulcer Prevention

Despite the attention given to the prevention of pressure ulcers, they continue to be a common occurrence among individuals with SCI.For many patients admitted to hospital with a pressure ulcer it is often their first time although there is a group of patients who have recurring pressure ulcers. For some of these individuals the recurrence is due to noncompliance with prevention strategies, possibly related to lack of incentives to maintain healthy behaviours (Jones et al. 2003). What is not known is whether rewarding positive prevention strategies, a proven behaviour change approach, would reduce the severity of pressure ulcers or prevent them entirely, and if the results would be sustainable once the rewards are withdrawn.

Table: Effect of Behavioural Contingencies on Pressure Ulcer Prevention Post SCI

Discussion

Jones et al. (2003) examined the effectiveness of several behavioural strategies (i.e., rewards, counselling and creation of an action plan) in four small pilot studies that examined pressure sore status and health care utilization. Results from the first study showed average Pressure Ulcer Scale for Healing (PUSH) scores were lower by 10.5 points from baseline; no hospitalizations were required and costs declined from $6,263.00 (US) to $235.00 (US). In the post-intervention phase, three subjects were able to maintain the lower PUSH scores and three were not. In the second study the results were highly variable. Mean PUSH scores decreased from baseline by 8.3 points (visits only) and a further 3.1 points when payments were added. For two or three participants PUSH scores rose again during the post-intervention phase. The mean number of hospitalizations dropped from 1.67 (baseline) to 0.33 (intervention and post-intervention).

Although this was a very small study, data from the first study indicated that when behavioural contingencies were introduced, positive behaviours resulted. As well, this is one of the few prevention studies that did not use indirect outcome measures. For some participants results were sustainable once behavioural contingencies were withdrawn. More research is needed to determine the role of behavioural contingencies (i.e., rewards) and other behavioural strategies in pressure ulcer prevention post SCI.

Conclusion

There is level 4 evidence (from one pre-post study; Jones et al. 2003) to suggest that the introduction of behavioural contingencies and other behavioural strategies is associated with a reduction in pressure ulcer severity and decreased health care costs.

  • Research is needed to determine the role of behavioural contingencies and other behavioural strategies in pressure ulcer prevention post SCI.

  • Research is needed to determine why some individuals adhere to pressure ulcer prevention strategies and others do not.