Purpose: To assess the relationship of psychological, environmental, and behavioral factors with pressure ulcers (PUs) in persons with spinal cord injury (SCI). Methods: A total of 1,549 participants from a large rehabilitation hospital in the southeast United States answered questions regarding outcomes after SCI. Variables from each set of factors were entered sequentially into the model: (1) psychological and environmental, and (2) behavioral. Results: Forty-eight percent of participants reported having a PU in the past year. After entering behavioral variables into the model, all environmental and psychological variables became nonsignificant. Odds of having a PU increased 28% with each psychotropic medication taken weekly. Persons who smoked one or more packs of cigarettes daily had 2.82 times the odds of having a PU than persons who did not smoke. Increased hours out of bed were protective against PUs. Conclusion: This study demonstrated the importance of health behaviors in the occurrence of PUs after SCI. These health behaviors provide important targets for intervention for health care providers.

Redelings MD, Lee NE, Sorvillo F. Pressure ulcers: more lethal than we thought? Adv Skin Wound Care. 2005;18(7):367-372.
,
Pressure ulcers: more lethal than we thought?
,
Adv Skin Wound Care
, vol.
18
(pg.
367
-
372
)
Krause JS. Skin sores after spinal cord injury: relationship to life adjustment. Spinal Cord. 1998;36:51-56.
,
Skin sores after spinal cord injury: relationship to life adjustment
,
Spinal Cord
, vol.
36
(pg.
51
-
56
)
Jones ML, Marini I, Slate JR. Prevention practice differences among persons with spinal cord injuries who rarely versus frequently sustain pressure ulcers. Rehabil Counseling Bull. 2005;48(3):139-145.
,
Slate JR. Prevention practice differences among persons with spinal cord injuries who rarely versus frequently sustain pressure ulcers
,
Rehabil Counseling Bull
, vol.
48
(pg.
139
-
145
)
Krause JS, Coker JL, Charlifue S, Whiteneck GG. Health outcomes among Americans In-dians with spinal cord injury. Arch Phys Med Rehabil. 2000;81(7):924-931.
,
Health outcomes among Americans In-dians with spinal cord injury
,
Arch Phys Med Rehabil.
, vol.
81
(pg.
924
-
931
)
Saladin LS, Krause JS, Adkins RH. Pressure ulcer prevalence and barriers to treatment after spinal cord injury: comparisons of 4 groups based on race-ethnicity. NeuroRehabilitation. 2009;24(1):57-66.
,
Pressure ulcer prevalence and barriers to treatment after spinal cord injury: comparisons of 4 groups based on race-ethnicity
,
NeuroRehabilitation
, vol.
24
(pg.
57
-
66
)
Krause JS. Secondary conditions and spinal cord injury: a model for prediction and prevention. Top Spinal Cord Inj Rehabil. 1996;2(2):217-227.
,
Secondary conditions and spinal cord injury: a model for prediction and prevention
,
Top Spinal Cord Inj Rehabil.
, vol.
2
(pg.
217
-
227
)
Krause JS, Carter RE, Pickelsimer E, Wilson D. A prospective study of health and risk of mortality after spinal cord injury. Arch Phys Med Rehabil. 2008;89:1482-1491.
,
A prospective study of health and risk of mortality after spinal cord injury
,
Arch Phys Med Rehabil.
, vol.
89
(pg.
1482
-
1491
)
Krause JS, Carter RE, Pickelsimer E. Behavioral risk factors of mortality after spinal cord injury. Arch Phys Med Rehabil. 2009;90(1):95-101.
,
Behavioral risk factors of mortality after spinal cord injury
,
Arch Phys Med Rehabil.
, vol.
90
(pg.
95
-
101
)
Krause JS, Carter RE. Risk of mortality after spinal cord injury: relationship with social support, education, and income. Spinal Cord. 2009;47(8):592-596.
,
Risk of mortality after spinal cord injury: relationship with social support, education, and income
,
Spinal Cord
, vol.
47
(pg.
592
-
596
)
Krause JS, Carter R, Zhai Y, Reed K. Psychologic factors and risk of mortality after spinal cord injury. Arch Phys Med Rehabil. Apr 2009;90(4):628-633.
,
Psychologic factors and risk of mortality after spinal cord injury
,
Arch Phys Med Rehabil.
, vol.
90
(pg.
628
-
633
)
Krause JS, Zhai Y, Saunders LL, Carter RE. Risk of mortality after spinal cord injury: an 8-year prospective study. Arch Phys Med Rehabil. 2009;90(10):1708-1715.
,
Risk of mortality after spinal cord injury: an 8-year prospective study
,
Arch Phys Med Rehabil.
, vol.
90
(pg.
1708
-
1715
)
Fuhrer MJ, Garber SL, Rintala DH, Clearman R, Hart KA. Pressure ulcers in community-resident persons with spinal cord injury: prevalence and risk factors. Arch Phys Med Rehabil. 1993;74(11):1172-1177.
,
Pressure ulcers in community-resident persons with spinal cord injury: prevalence and risk factors
,
Arch Phys Med Rehabil.
, vol.
74
(pg.
1172
-
1177
)
Vidal JS, M. An analysis of the diverse factors concerned with the development of pressure sores in spinal cord injured patients. Paraplegia. 1991;29:261-267.
,
An analysis of the diverse factors concerned with the development of pressure sores in spinal cord injured patients
,
Paraplegia
, vol.
29
(pg.
261
-
267
)
Chen Y, Devivo MJ, Jackson AB. Pressure ulcer prevalence in people with spinal cord injury: age-period-duration effects. Arch Phys Med Rehabil. 2005;86(6):1208-1213.
,
Pressure ulcer prevalence in people with spinal cord injury: age-period-duration effects
,
Arch Phys Med Rehabil.
, vol.
86
(pg.
1208
-
1213
)
Kroll T, Neri MT, Ho PS. Secondary conditions in spinal cord injury: results from a prospective survey. Disabil Rehabil. 2007;29(15):1229-1237.
,
Secondary conditions in spinal cord injury: results from a prospective survey
,
Disabil Rehabil.
, vol.
29
(pg.
1229
-
1237
)
Krause JS, Vines CL, Farley TL, Sniezek J, Coker J. An exploratory study of pressure ulcers after spinal cord injury: relationship to protective behaviors and risk factors. Arch Phys Med Rehabil. 2001;82(1):107-113.
,
An exploratory study of pressure ulcers after spinal cord injury: relationship to protective behaviors and risk factors
,
Arch Phys Med Rehabil.
, vol.
82
(pg.
107
-
113
)
Schryvers OI, Stranc MF, Nance PW. Surgical treatment of pressure ulcers: 20-year experience. Arch Phys Med Rehabil. 2000;81(12):1556-1562.
,
Surgical treatment of pressure ulcers: 20-year experience
,
Arch Phys Med Rehabil.
, vol.
81
(pg.
1556
-
1562
)
Elliott TR, Bush BA, Chen Y. Social problem-solving abilities predict pressure sore occurrence in the first 3 years of spinal cord injury. Rehabil Psychol. 2006;51(1):69-77.
,
Social problem-solving abilities predict pressure sore occurrence in the first 3 years of spinal cord injury
,
Rehabil Psychol.
, vol.
51
(pg.
69
-
77
)
Correa GI, Fuentes M, Gonzalez X, Cumsille F, Pineros JL, Finkelstein J. Predictive factors for pressure ulcers in the ambulatory stage of spinal cord injury patients. Spinal Cord. 2006;44:734-739.
,
Predictive factors for pressure ulcers in the ambulatory stage of spinal cord injury patients
,
Spinal Cord
, vol.
44
(pg.
734
-
739
)
Krause JS, Broderick L. Patterns of recurrent pressure ulcers after spinal cord injury: identification of risk and protective factors 5 or more years after onset. Arch Phys Med Rehabil. 2004;85:1257-1264.
,
Patterns of recurrent pressure ulcers after spinal cord injury: identification of risk and protective factors 5 or more years after onset
,
Arch Phys Med Rehabil.
, vol.
85
(pg.
1257
-
1264
)
Lamid S, El Ghatit AZ. Smoking, spasticity and pressure sores in spinal cord injured patients. Am J Phys Med. 1983;62(6):300-306.
,
Smoking, spasticity and pressure sores in spinal cord injured patients
,
Am J Phys Med.
, vol.
62
(pg.
300
-
306
)
Niazi BM, Slalzberg CA, Byrne DW, Viehbeck M. Recurrence of initial pressure ulcer in persons with spinal cord injuries. Adv Wound Care. 1997;10(3):38-42.
,
Recurrence of initial pressure ulcer in persons with spinal cord injuries
,
Adv Wound Care
, vol.
10
(pg.
38
-
42
)
Hawkins DA, Heinemann A. Substance use and medical complications following spinal cord injury. Rehabil Psychol. 1998;43:219-231.
,
Substance use and medical complications following spinal cord injury
,
Rehabil Psychol.
, vol.
43
(pg.
219
-
231
)
Tate DG, Forchheimer M, Krause JS, Meade MA, Bombardier CH. Patterns of alcohol and substance use and abuse in persons with spinal cord injury risk factors and correlates. Arch Phys Med Rehabil. 2004;85:1837-1847.
,
Patterns of alcohol and substance use and abuse in persons with spinal cord injury risk factors and correlates
,
Arch Phys Med Rehabil.
, vol.
85
(pg.
1837
-
1847
)
Ek AC, Unosson JL, Von Schenck H, Bjurulf P. The development and healing of pressure sores related to the nutritional state. Clin Nutrition. 1991;10:245-250.
,
The development and healing of pressure sores related to the nutritional state
,
Clin Nutrition
, vol.
10
(pg.
245
-
250
)
Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173-1182.
,
The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations
,
J Pers Soc Psychol.
, vol.
51
(pg.
1173
-
1182
)
Krause JS, Reed KS, McArdle JJ. A structural anlaysis of health outcomes after spinal cord injury. J Spinal Cord Med. 2010;33(1):22-32.
,
A structural anlaysis of health outcomes after spinal cord injury
,
J Spinal Cord Med.
, vol.
33
(pg.
22
-
32
)
Bennett MA. Report of the task force on the implications for darkly pigmented intact skin in the prediction and prevention of pressure ulcers. Adv Wound Care. 1995;8(6):34-35.
,
Report of the task force on the implications for darkly pigmented intact skin in the prediction and prevention of pressure ulcers
,
Adv Wound Care
, vol.
8
(pg.
34
-
35
)
Zuckerman M, Kuhlman DM, Joireman J, Teta P, Kraft M. A comparison of three structural models for personality, The Big Three, The Big Five and The Alternate Five. J Pers Social Psychol. 1993;65:757-768.
,
A comparison of three structural models for personality, The Big Three, The Big Five and The Alternate Five
,
J Pers Social Psychol.
, vol.
65
(pg.
757
-
768
)
Schwarzer R, Schulz U. Berlin Social Support Scales (BSSS). 2000. Available at: http://userp-age.fu-berlin.de/~health/bsss.htm. Accessed January 22, 2007. http://userp-age.fu-berlin.de/~health/bsss.htm
Hosmer DW, Lemeshow S. Applied Logistic Regression. 2nd ed. New York: John Wiley and Sons; 2000.
,
Applied Logistic Regression
Noreau L, Fougeyrollas P. Long-term consequences of spinal cord injury on social participation: the occurrence of handicap situations. Disabil Rehabil. 2000;22(4):170-180.
,
Long-term consequences of spinal cord injury on social participation: the occurrence of handicap situations
,
Disabil Rehabil.
, vol.
22
(pg.
170
-
180
)
Tate D, Forchheimer M, Maynard F, Dijkers M. Predicting depression and psychological distress in persons with spinal cord injury based on indicators of handicap. Am J Phys Med Rehabil. 1994;73(3):175-183.
,
Predicting depression and psychological distress in persons with spinal cord injury based on indicators of handicap
,
Am J Phys Med Rehabil.
, vol.
73
(pg.
175
-
183
)
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