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There is level 4 evidence (from one observational study; Guihan et al. 2004) that supports the use of a handheld dermal phase meter for the early detection of pressure ulcers secondary to SCI.

There is level 2 evidence (from one prospective controlled trial; Kanno et al. 2009) that supports the use of ultrasonography to extend the yield of routine inspection and palpation of suspected or early stage pressure ulcers in people with SCI.

There is level 3 evidence (from one case control study; de Heredia et al. 2012) that magnetic resonance imaging can predict the development of osteomyelitis in non-healing pelvic pressure ulcers in patients.

There is level 4 evidence (from one case series study; Loerakker et al. 2012) that reliance on circulatory biomarkers as an indication of muscle damage secondary to deep tissue injury in the SCI population cannot be recommended at this time.

There is level 2 evidence (from one prospective controlled trial and one cohort study; Lui et al. 2006b; Ferguson et al. 1992) supported by level 4 evidence (from five pre-post studies, and two case series studies; Smit et al. 2012, 2013a, 2013b; Gyawali et a. 2011; Bogie & Triolo 2003; Van London et al. 2008; Liu et al. 2006a) that electrical stimulation decreases ischial pressures post SCI.

There is level 4 evidence (from one pre-post study; Bogie & Triolo 2003) that electrical stimulation may increase blood flow at sacral and gluteal areas post SCI.

There is level 2 evidence (from two prospective controlled trials and one pre-post study; Lui et al. 2006a; Mawson et a 1993; Bogie & Triolo 2003) that electrical stimulation may increase tissue oxygenation post SCI.

There is level 2 evidence (from one prospective controlled trial; Hobson 1992) to support not generalizing pressure mapping data from able-bodied subject to SCI subjects.

There is level 4 evidence (from one case control study; Gutierrez et al. 2004) to support the typical locations for high pressure in the SCI population being the ischial tuberosities and the coccyx.

There is level 4 evidence (from one prospective controlled trial; Brienza & Karg 1998) to support not generalizing pressure mapping data from the elderly population to the SCI population.

There is level 2 evidence (from one cohort study; Kennedy et al. 2003) showing that early attendance at specialized seating assessment clinics increases the skin management abilities of individuals post SCI.

There is level 1b evidence (from two randomized controlled trials and three pre-post studies; Rintala et al. 2008; Garber et al. 2002; May et al. 2006; Brace & Schubart 2010; Schubart et al. 2012) that providing enhanced pressure ulcer prevention education is effective at helping individuals with SCI gain and retain this knowledge.

There is level 4 evidence (from two pre-post studies; Schubart et al. 2012; Brace & Schubart 2010) that online eLearning modules may improve knowledge on prevention of pressure ulcers among persons with SCI.

There is level 1b evidence (from one randomized controlled trial; Rintala et al. 2008) 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.

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.

There is level 1b evidence (from a randomized controlled trial; Houlihan et al. 2013) that telerehabilitation using an automated call-in system with built-in theory-based behavior change strategies may make a significant difference for women but not men in preventing pressure ulcers post SCI.

There is level 4 evidence (from one case series; Vesmarovich et al. 1999) that telerehabilitation via videophone to support clinical interactions and digital photography does not make a significant difference in the prevention and treatment of pressure ulcers post SCI.

More research is needed to determine what telerehabilitation strategies are effective in preventing pressure ulcers, improving healing and reducing costs.

There is level 1 evidence (from six randomized controlled trials; Houghton et al. 2010; Cukjati et al. 2001; Adegoke & Badmos 2001; Karba 1997; Jercinovic 1994; Griffin 1991) that electrical stimulation accelerates the healing rate of stage III and IV pressure ulcers when combined with standard wound management.

There is level 1 evidence (from two randomized controlled trials; Taly et al. 2004; Nussbaum et al. 1994) that laser treatment has no added benefit in pressure ulcer healing post SCI than standard wound care alone.

There is level 1b evidence (from one randomized controlled trial; Nussbaum et al. 1994) that the combination of ultrasound/ultraviolet C with standard wound care decreases wound healing time of pressure ulcers post SCI; there is no evidence to support the benefit of either therapy used individually.

There is level 1b evidence (from one randomized controlled trial; Salzberg et al. 1995) that pulsed electromagnetic energy accelerates healing of stage II and III pressure ulcers post SCI.

There is level 1a evidence (from one randomized controlled trial and one pre-post study; De Laat et al. 2011; Coggrove et al. 2012) that topical negative pressure facilitates wound healing for pressure ulcers in people with SCI and other patient etiologies. This conclusion is contradicted by level 5 evidence (from one observational study; Ho et al. 2010) but there are significant limitations in the latter study.

There is level 2 evidence (from one prospective controlled trial; Kloth et al. 2001) that normothermic dressings may improve healing of pressure ulcers post SCI.

There is level 4 evidence (from one case series; Keast & Fraser 2004) that recombinant human erythropoietin aids in the healing of stage IV chronic non-healing pressure ulcers post SCI.

There is level 5 evidence (from one case series and one case study; Sell et al. 2011; De Angelis et al. 2012) that supports the possibility of platelet-rich plasma therapy facilitation of reactivated healing in severe, non-healing pressure ulcers, post SCI.

There is level 2 evidence (from one flawed randomized controlled trial; Bauman et al. 2013) that does not support the use of oxandrolone (anabolic steroid) to facilitate healing of serious pressure ulcers post SCI. However, very limited, earlier level 4 evidence (from one case series; Spungeon et al. 2001) did lend some support for the use of oxandrolone to promote healing of stage III and IV pressure ulcers post SCI.

There is Level 1 evidence (from one randomized controlled trial; Hollisaz et al. 2004) that completion of healing for stage I and II pressure ulcers is greater with an occlusive hydrocolloid dressing compared to phenytoin cream or simple dressing post SCI.

There is Level 2 evidence (from one randomized controlled trial; Kaya et al. 2005) that occlusive hydrogel-type dressings heal more pressure ulcers than conservative treatment post SCI.

There is level 1 evidence (from one randomized controlled trial; Subbanna et al. 2007) that topical phenytoin shows a trend towards healing of stage I and II pressure ulcers post SCI.

There is level 2 evidence (from one randomized controlled trial; Scevola et al. 2010) that platelet gel dressings, when used within the first 2 weeks of treatment can trigger earlier granulation tissue proliferation towards pressure ulcer healing, post SCI.

Level 1 evidence (from one randomized controlled trial; Ho et al. 2012) underpins the use of pulsatile lavage hydrotherapy debridement for Stage III and IV pressure ulcers secondary to SCI.

There is level 5 evidence (from one observational study; Bogie et al. 2013) that pulsatile lavage therapy, used in conjunction with standard infection control standards, is likely a safe debridement method for Stage III and IV pressure ulcers in people with SCI.

There is level 2 evidence (from one prospective controlled trial and one observational study; Wang et al. 2010; Sherman et al. 1995) that supports the use of maggot therapy as an adjunctive therapy for pressure ulcer debridement post SCI.

There is level 4 evidence (from one post-test study; Erba et al. 2010) that supports the use of silicone moulding as a radical en bloc debridement method for pyramidal shaped grade IV pressure ulcer cavities in people with SCI.

There is level 4 evidence (from one pre-post study; Banks & Ho 2008) that topical oxygen therapy may improve healing of pressure ulcers post SCI.

There is level 5 evidence that supports various surgical repair methods for persistent, severe thigh and buttock pressure ulcers secondary to SCI, as a beneficial treatment option.

There is level 4 evidence (from one pre-post study; Biglari et al. 2012) that supports the use of Medihoney for improved healing rate as well as residual soft, elastic scars in persistent stage III and IV pressure ulcers in individuals with SCI.

There is level 3 evidence (from one case control study; Liu et al. 2013) that supports the use of Cured Rot and Flat Sore Ointment over Arnebia Root Oil to accelerate pressure ulcer healing but it needs to be noted that objective outcome assessment was not clearly outlined.

There is level 4 evidence (from one pre-post study; Brewer et al. 2010) for arginine supplementation for pressure ulcer healing.

There is level 2 evidence (from one prospective controlled trial; Tzen et al. 2013) that localized cooling is not a viable pressure ulcer prevention strategy that is effective for individuals with SCI. Conversely, with neurological control of vasoconstriction and capillary smooth muscle contraction, those without SCI may benefit from microclimate controlled surfaces as a pressure ulcer prevention strategy.