Pressure ulcers (PUs) continue to be prevalent despite technologic advances in equipment development and repeated attempts to improve education and preventive efforts. Diligence and timeliness of adequate pressure relief are felt to be the cornerstone to PU prevention. The evidence supporting clinical recommendations for pressure relief is lacking, however, leading to inconsistencies in clinical guidelines. The purpose of this study is to contribute to the evidence base on PU pathophysiology and prevention in people with spinal cord injury (SCI) by delineating the microvascular mechanisms that occur during sitting and pressure relief maneuvers, including perfusion, oxygenation, and interface pressure. By understanding these key physiologic responses, health care professionals and consumers with SCI will be enabled to more effectively prevent the onset of PUs. The overriding goal of this project is to develop an algorithm that will assist clinicians in providing individualized recommendations specifying optimal pressure relief technique, duration, and frequency to reduce PU incidence in consumers with SCI.
Whittington KT, Briones R. National prevalence and incidence study: 6-year sequential acute care data. Adv Skin Wound Care. 2004;17:490-494.
,
National prevalence and incidence study: 6-year sequential acute care data
, Adv Skin Wound Care.
, vol. 17
(pg. 490
-494
) Cuddigan J, Berlowitz D, Ayello EA. Pressure ulcers in America: prevalence, incidence and implications for the future. Adv Skin Wound Care. 2001;14(4):208-215.
,
Pressure ulcers in America: prevalence, incidence and implications for the future
, Adv Skin Wound Care.
, vol. 14
(pg. 208
-215
) European Pressure Ulcer Advisory Panel. A European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel Collaborative Guideline. http://www.epuap.org/review72/page8.html. Accessed March 30, 2008. http://www.epuap.org/review72/page8.html.
Clark M, Bours G, Defloor T. Summary report on prevalence of pressure ulcers. EPUAP Rev. 2002;4(2):49-57.
,
Summary report on prevalence of pressure ulcers
, EPUAP Rev.
, vol. 4
(pg. 49
-57
) Fogerty MD, Abumrad NN, Nanney L, Arbogast PG, Poulose B, Barbul A. Risk factors for pressure ulcers in acute care hospitals. Wound Repair Regen. 2008;16(1):11-18.
,
Risk factors for pressure ulcers in acute care hospitals
, Wound Repair Regen.
, vol. 16
(pg. 11
-18
) Sheerin F, Gillick A, Doyle B. Pressure ulcers and spinal-cord injury: incidence among admissions to the Irish national specialist unit. J Wound Care. 2005;14:112-115.
,
Pressure ulcers and spinal-cord injury: incidence among admissions to the Irish national specialist unit
, J Wound Care.
, vol. 14
(pg. 112
-115
) Caliri MHL. Spinal cord injury and pressure ulcers. Nurs Clin North Am. 2005;40:337-347.
,
Spinal cord injury and pressure ulcers
, Nurs Clin North Am.
, vol. 40:337-347
(pg. 337
-347
) Benbow M. Pressure ulcer incidence reporting. Nurs Stand. 2004;18:57-66.
,
Pressure ulcer incidence reporting
, Nurs Stand.
, vol. 18
(pg. 57
-66
) DeLisa JA, Mikulic MA. Pressure ulcers: what do we do if preventive management fails. Pressure Ulcers. 1985; 77:209-212.
,
Pressure ulcers: what do we do if preventive management fails
, Pressure Ulcers.
, vol. 77
(pg. 209
-212
) Regan MA, Teasell RW, Wolfe DL, Keast D, Mortenson WB, Aubut JL. A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury. Arch Phys Med Rehabil. 2009;90:213-231.
,
A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury
, Arch Phys Med Rehabil.
, vol. 90
(pg. 213
-231
) Chen Y, DeVivo MJ, Jackson AB. Pressure ulcer prevalence in people with spinal cord injury: age-period-duration effects Arch Phys Med Rehabil. 2005;86:1208-1213
,
Pressure ulcer prevalence in people with spinal cord injury: age-period-duration effects.
, Arch Phys Med Rehabil.
, vol. 86
(pg. 1208
-1213
) McKinley WO, Jackson AB, Cardenas DD, DeVivo MJ. Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis. Arch Phys Med Rehabil. 1999;80(11):1402-1410.
,
Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis
, Arch Phys Med Rehabil.
, vol. 80
(pg. 1402
-1410
) Armstrong DG, Lavery LA, Wrobel JS, Vileikyte L. Quality of life in healing diabetic wounds: does the end justify the means? J Foot Ankle Surg. 2008;47(4):278-282.
,
Quality of life in healing diabetic wounds: does the end justify the means?
, J Foot Ankle Surg.
, vol. 47
(pg. 278
-282
) Shukla VK, Shukla D, Tripathi AK, Agrawal S, Tiwary SK, Prakash V. Results of a one-day descriptive study of quality of life in patients with chronic wounds. Ostomy Wound Manage. 2008;54(5):43-49.
,
Results of a one-day descriptive study of quality of life in patients with chronic wounds
, Ostomy Wound Manage.
, vol. 54
(pg. 43
-49
) Shukla D, Tripathi AK, Agrawal S, Ansari MA, Rastoqi A, Shukla VK. Pain in acute and chronic wounds: a descriptive study. Ostomy Wound Manage. 2005; 51(11):47-51.
,
Pain in acute and chronic wounds: a descriptive study
, Ostomy Wound Manage.
, vol. 51
(pg. 47
-51
) Mullins, M, Thomason, SS Thompson, M Legro. Monitoring pressure ulcer healing in persons with disabilities. Rehabil Nurs. 2005;30:92-99.
,
Legro. Monitoring pressure ulcer healing in persons with disabilities
, Rehabil Nurs.
, vol. 30
(pg. 92
-99
) Bansal C, Scott R, Stewart D, Cockerell CJ. Decubitus ulcers: a review of literature. Int J Dermatol. 2005;44:805-810.
,
Decubitus ulcers: a review of literature
, Int J Dermatol.
, vol. 44
(pg. 805
-810
) Scott JR, Gibran NS, Engrave LH, Mack CD, Rivara FP. Incidence and characteristics of hospitalized patients with pressure ulcers: state of Washington, 1987 to 2000. Plastic Reconstruct Surg. 2006;117:630-634.
,
Incidence and characteristics of hospitalized patients with pressure ulcers: state of Washington, 1987 to 2000
, Plastic Reconstruct Surg.
, vol. 117
(pg. 630
-634
) Consortium for Spinal Cord Medicine. Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury: A Clinical Practice Guideline for Health-care Professionals. Washington, DC: Paralyzed Veterans of America; August 2000.
,
Consortium for Spinal Cord Medicine
, Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury: A Clinical Practice Guideline for Health-care Professionals.
Consortium for Spinal Cord Medicine. Pressure Ulcer’s: What You Should Know. A Guide for People with Spinal Cord Injury. Washington, DC: Paralyzed Veterans of America; August 2000.
,
Consortium for Spinal Cord Medicine
, Pressure Ulcer’s: What You Should Know. A Guide for People with Spinal Cord Injury.
Panel for the Prediction and Prevention of Pressure Ulcers in Adults. Pressure Ulcers in Adults: Prediction and Prevention. Clinical Practice Guideline, No. 3. Rockville, MD: Agency for Health Care Policy & Research, Public Health Service, U.S. Department of Health & Human Services, May 1992. AHCPR Publication No. 92-0047.
,
Panel for the Prediction and Prevention of Pressure Ulcers in Adults
, Pressure Ulcers in Adults: Prediction and Prevention. Clinical Practice Guideline, No. 3.
Bergstrom N, Horn SD, Smout RJ, Bender, SA, Ferguson ML, Taler G. The national pressure ulcer long-term care study: outcomes of pressure ulcer treatments in long-term care. J Am Geriatr Soc. 200;53:1721-1729.
,
Ferguson ML, Taler G. The national pressure ulcer long-term care study: outcomes of pressure ulcer treatments in long-term care
, J Am Geriatr Soc.
, vol. 53
(pg. 1721
-1729
) Gawlitta D, Li W, Oomens CW, Baaijens FP, Bader DL, Bouten C. The relative contributions of compression and hypoxia to development of muscle tissue damage: an in vitro study. Ann Biomed Eng. 2007;35(2):273-284.
,
The relative contributions of compression and hypoxia to development of muscle tissue damage: an in vitro study
, Ann Biomed Eng.
, vol. 35
(pg. 273
-284
) Gawlitta D, Oomens CW, Bader DL, Baaijens FP, Bouten CV. Temporal differences in the influence of ischemic factors and deformation on the metabolism of engineered skeletal muscle J Appl Phys. 2007;103(2):464-473.
,
Temporal differences in the influence of ischemic factors and deformation on the metabolism of engineered skeletal muscle.
, J Appl Phys.
, vol. 103
(pg. 464
-473
) Yamanaka M, Ishikawa O. Hypoxic conditions decrease the mRNA expression of pralpha 1(I) and (III) collagens and increase matrix metalloproteinases of dermal fibroblast in three-dimensional cultures. J Dermatol Sci. 2000; 24:99-104.
,
Hypoxic conditions decrease the mRNA expression of pralpha 1(I) and (III) collagens and increase matrix metalloproteinases of dermal fibroblast in three-dimensional cultures
, J Dermatol Sci.
, vol. 24
(pg. 99
-104
) Steinbrech DS, Longaker MT, Mehrara BJ, et al. Fibroblast response to hypoxia: the relationship between angiogenesis and matrix regulation. J Surg Res. 1999;84(2):127-133.
,
Fibroblast response to hypoxia: the relationship between angiogenesis and matrix regulation
, J Surg Res.
, vol. 84
(pg. 127
-133
) Shuber VB, Fagrell B. Local skin pressure and its effects on skin microcirculation as evaluated by laster-Doppler fluxmetry. Clin Physiol. 1989;9:535-545.
,
Local skin pressure and its effects on skin microcirculation as evaluated by laster-Doppler fluxmetry
, Clin Physiol.
, vol. 9
(pg. 535
-545
) Thorfinn J, Sjoberg F, Sjostrand L, Lidman D. Perfusion of the skin of the buttocks in paraplegic and tetraplegic patients, and in healthy subjects after a short and long load. Scand J Plast Reconstr Surg Hand Surg. 2006;40:153-160.
,
Perfusion of the skin of the buttocks in paraplegic and tetraplegic patients, and in healthy subjects after a short and long load
, Scand J Plast Reconstr Surg Hand Surg.
, vol. 40
(pg. 153
-160
) Thorfinn J, Sjoberg F, Lidman D. Sitting pressure and perfusion of buttock skin in paraplegic and tetraplegic patients, and in healthy subjects: a comparative study. Scand J Plast Reconstr Surg Hand Surg. 2002;36:279-283.
,
Sitting pressure and perfusion of buttock skin in paraplegic and tetraplegic patients, and in healthy subjects: a comparative study
, Scand J Plast Reconstr Surg Hand Surg.
, vol. 36
(pg. 279
-283
) Herrman EC, Knapp CF, Donofrio JC, Salcido R. Skin perfusion response to surface pressure-induced ischemia: implications for the developing pressure ulcer. J Rehabil Res Dev. 1999;36:109-120.
,
Skin perfusion response to surface pressure-induced ischemia: implications for the developing pressure ulcer
, J Rehabil Res Dev.
, vol. 36
(pg. 109
-120
) National Pressure Ulcer Advisory Panel (NPUAP). Pressure ulcer stages revised by NPUAP. 2007. http://www.npuap.org/pr2. htm. Accessed July 24, 2009. http://www.npuap.org/pr2.
Sae-Sia W, Wipke-Tevis DD, Williams DA. The effect of clinically relevant pressure duration on sacral skin blood flow and temperature in patients after acute spinal cord injury. Arch Phys Med Rehabil. 2007;88(12):1673-1680.
,
The effect of clinically relevant pressure duration on sacral skin blood flow and temperature in patients after acute spinal cord injury
, Arch Phys Med Rehabil.
, vol. 88
(pg. 1673
-1680
) Breuls RB, Bouten CV, Oomens CW, Bader DL, Baaijens FP. A theoretical analysis of damage evolution in skeletal muscle tissue with reference to pressure ulcer development. J Biomed Eng. 2003;125(6):902-909.
,
A theoretical analysis of damage evolution in skeletal muscle tissue with reference to pressure ulcer development
, J Biomed Eng.
, vol. 125
(pg. 902
-909
) Breuls RG, Bouten CV, Oomens CW, Bader DL, Baaijens FP. Compression induced cell damage in engineered muscle tissue: an in vitro model to study pressure ulcer aetiology. Ann Biomed Eng. 2003;31(11):1357-1364.
,
Compression induced cell damage in engineered muscle tissue: an in vitro model to study pressure ulcer aetiology
, Ann Biomed Eng.
, vol. 31
(pg. 1357
-1364
) Breuls RG, Bouten CV, Oomens CW, Bader DL, Baaijens FP. Compression induced cell damage in engineered muscle tissue: an in vitro model to study pressure ulcer etiology. Ann Biomed Eng. 2003;31(11):1357-1364.
,
Compression induced cell damage in engineered muscle tissue: an in vitro model to study pressure ulcer etiology
, Ann Biomed Eng.
, vol. 31
(pg. 1357
-1364
) Bergstrom N, Braden N. A prospective study of pressure sore risk among institutionalized elderly. J Am Geriatr Soc. 1992;40:747-758.
,
A prospective study of pressure sore risk among institutionalized elderly
, J Am Geriatr Soc.
, vol. 40
(pg. 747
-758
) Nixon V. Pressure relief. In: Spinal Cord Injury: A Guide to Functional Outcomes in Physical Therapy Management. Rockville, MD: Aspen Publishers ; 1985:67-75.
,
Pressure relief. In
, Spinal Cord Injury: A Guide to Functional Outcomes in Physical Therapy Management.
(pg. 67
-75
) Coggrave MJ, Rose LS. A specialist seating assessment clinic: changing pressure relief practice. Spinal Cord. 2003;41:692-695.
,
A specialist seating assessment clinic: changing pressure relief practice
, Spinal Cord.
, vol. 41
(pg. 692
-695
) Makhsous M, Priebe M, Bankard J, et al. Measuring tissue perfusion during pressure relief maneuvers: insights into preventing pressure ulcers. J Spinal Cord Med. 2007;30:497-507.
,
Measuring tissue perfusion during pressure relief maneuvers: insights into preventing pressure ulcers
, J Spinal Cord Med.
, vol. 30
(pg. 497
-507
) Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7:10.
,
Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews
, BMC Med Res Methodol.
, vol. 7
pg. 10
Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924.
,
GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.
, BMJ.
, vol. 336
pg. 924
Ramella-Roman JC, Hidler JM. The impact of autonomic dysreflexia on blood flow and skin response in individuals with spinal cord injury. Adv Optical Technol. 2008:1-7. ID 797214.
,
The impact of autonomic dysreflexia on blood flow and skin response in individuals with spinal cord injury
, Adv Optical Technol.
Ramella-Roman J, Basiri A, Hidler J, Ljungberg I, Groah S. Autonomic dysreflexia in spinal cord injury: its role in altering skin perfusion and oxygenation. Topics Spinal Cord Inj Rehabil. 2011;16(3):46-57.
,
Autonomic dysreflexia in spinal cord injury: its role in altering skin perfusion and oxygenation
, Topics Spinal Cord Inj Rehabil.
, vol. 16
(pg. 46
-57
) Doughty DB. Prevention and early detection of pressure ulcers in hospitalized patients. JWOCN. 2008;35:76-78.
,
Prevention and early detection of pressure ulcers in hospitalized patients
, JWOCN.
, vol. 35
(pg. 76
-78
) Wong VK, Stotts NA, Hpf HW, Froelicher ES, Dowling GA. How heel oxygenation changes under pressure. Wound Rep Regen. 2007;15:786-794.
,
How heel oxygenation changes under pressure
, Wound Rep Regen.
, vol. 15
(pg. 786
-794
) Altman DG, Bland JM. How to randomize. BMJ. 1999;319(7211):703-704.
,
How to randomize
, BMJ.
, vol. 319
(pg. 703
-704
)
This content is only available as a PDF.
