Preventing recurrent pressure ulcers in veterans with spinal cord injury: impact of a structured education and follow-up intervention

Arch Phys Med Rehabil. 2008 Aug;89(8):1429-41. doi: 10.1016/j.apmr.2008.01.015.


Objective: To test the hypothesis that enhanced education and structured follow-up after pressure ulcer surgery will result in fewer recurrences.

Design: Randomized controlled trial.

Setting: Veterans Affairs medical center.

Participants: Forty-nine veteran men with spinal cord injury or dysfunction were approached on admission for pressure ulcer surgery. Five never had surgery, 2 refused to participate, and one withdrew. Forty-one were randomized into 3 groups. Three participants' ulcers did not heal, so follow-up could not begin.

Interventions: Group 1 received individualized pressure ulcer education and monthly structured telephone follow-up (n=20); group 2 received monthly mail or telephone follow-up without educational content (n=11); and group 3 received quarterly mail or telephone follow-up without educational content (n=10). Follow-up continued until recurrence, death, or 24 months.

Main outcome measure: Time to pressure ulcer recurrence.

Results: Group 1 had a longer average time to ulcer recurrence or end of study than groups 2 and 3 (19.6 mo, 10.1 mo, 10.3 mo; P=.002) and had a smaller rate of recurrence (33%, 60%, 90%; P=.007). Survival analysis confirmed these findings (P=.009).

Conclusions: Individualized education and structured monthly contacts may be effective in reducing the frequency of or delaying pressure ulcer recurrence after surgical repair of an ulcer.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Disease-Free Survival
  • Follow-Up Studies
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Patient Education as Topic / statistics & numerical data*
  • Pressure Ulcer / etiology
  • Pressure Ulcer / prevention & control*
  • Pressure Ulcer / surgery
  • Risk Factors
  • Secondary Prevention
  • Spinal Cord Injuries / complications*
  • Survival Analysis
  • United States
  • Veterans / statistics & numerical data*