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Burkhart L, Skemp L, Siddiqui S. Triangulation of veteran and provider models of preventing community-acquired pressure injuries in spinal cord injury to reveal convergence and divergence of perspectives. J Spinal Cord Med 2024; 47:549-558. [PMID: 36441027 PMCID: PMC11218588 DOI: 10.1080/10790268.2022.2135714] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
CONTEXT/OBJECTIVE Community-acquired pressure injuries (CAPrI) are a common and costly complication of spinal cord injury (SCI). The majority of PrIs occur in the community, but there is little guidance in CAPrI prevention. This study describes how provider and veteran perspectives of CAPrI prevention converge and diverge. DESIGN The Farmer triangulation method was used to compare two models from previous qualitative research describing provider and veteran perspectives of CAPrI prevention based on the framework of CAPrI risks, resources, and preventive activities. The previous qualitative research revealed the provider model of CAPrI prevention using semi-structured interviews with interprofessional SCI providers at the Veteran Health Administration (VA) (n = 30). A qualitative descriptive design using photovoice (n = 30) with or without guided tours (n = 15) revealed the Veteran model of CAPrI prevention. SETTING The previous qualitative research was conducted at three geographically different VA spinal cord injury/disorder centers in the United States (north, south, west). PARTICIPANTS 30 interprofessional SCI providers; 30 Veterans living with SCI at three VA SCI Centers in the United States. INTERVENTIONS n/a. OUTCOME MEASURES Provider-Veteran perspectives of CAPrI prevention that demonstrated agreement, partial agreement, divergence, and silence. RESULTS Providers and veterans agreed on what is basic care, and the importance of family, caregiver and health provider/system supports, but they viewed motivation, veteran role, informal supports, and adequacy of supports differently. CONCLUSION Understanding how SCI providers and veterans living with SCI view prevention in the community informs how to promote preventive care in the context of veterans' lives.
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Affiliation(s)
- Lisa Burkhart
- Center of Innovation for Complex Chronic Healthcare, Hines VA, Hines, Illinois, USA
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
| | - Lisa Skemp
- Center of Innovation for Complex Chronic Healthcare, Hines VA, Hines, Illinois, USA
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA
| | - Sameer Siddiqui
- Spinal Cord Injuries/Disorders System of Care, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, USA
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Middleton JW, Arora M, Jerram KAS, Bourke J, McCormick M, O’Leary D, Weber G, Lembke T, Craig A. Co-design of the Spinal Cord Injury Health Maintenance Tool to Support Self-Management: A Mixed-Methods Approach. Top Spinal Cord Inj Rehabil 2024; 30:59-73. [PMID: 38433736 PMCID: PMC10906369 DOI: 10.46292/sci23-00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Background There is a lack of consumer-friendly tools to empower and support people living with spinal cord injury (SCI) to self-manage complex health needs in community. This article describes the co-design process of the new SCI Health Maintenance Tool (SCI-HMT). Methods Co-design of the SCI-HMT using a mixed-methods approach included a rapid review, e-Delphi surveys with range of multidisciplinary health care professionals (n = 62), interviews of participants with SCI (n = 18) and general practitioners (n = 4), focus groups (n = 3 with 7, 4, and 4 participants with SCI, respectively), design workshops with stakeholders (n = 11, 8), and end-user testing (n = 41). Results The SCI-HMT (healthmaintenancetool.com) was developed based on participatory research with data synthesis from multiple sources. Five priority health maintenance issues for bladder, bowel, skin, pain, and autonomic dysreflexia were originally covered. Best practice recommendations, red flag conditions, referrals, and clinical pathways were agreed on through an e-Delphi technique. Qualitative analysis identified six broad key concepts for self-management, including early symptom recognition, role of SCI peers, knowledge sharing with primary care, general practitioners as gatekeepers, and shared decision-making and highlighted a need to place much stronger emphasis on mental health and well-being. Design workshops and end-user testing provided key insights about user experience, functionality, and content for the SCI-HMT. Conclusion The co-design process engaging end users, including people with SCI and general practitioners, enabled a shared understanding of the problem and identification of important needs and how to meet them. Informed by this process, the SCI-HMT is a freely accessible resource supporting SCI self-management, shared decision-making, and early problem identification.
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Affiliation(s)
- James W. Middleton
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
- Royal Rehab, Ryde NSW Australia
- State Spinal Cord Injury Service, NSW Agency for Clinical Innovation, St Leonards, NSW Australia
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - K. Anne Sinnott Jerram
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - John Bourke
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
- Burwood Academy Trust, Burwood Hospital, Christchurch, New Zealand
| | | | | | | | - Tony Lembke
- The Alstonville Clinic, Alstonville, NSW Australia
| | - Ashley Craig
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
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Burkhart L, Skemp L, Siddiqui S. Veteran model of preventing community-acquired pressure injuries associated with spinal cord injury: A qualitative descriptive study. J Spinal Cord Med 2024; 47:110-124. [PMID: 34855569 PMCID: PMC10795614 DOI: 10.1080/10790268.2021.1982177] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CONTEXT/OBJECTIVE Pressure injuries (PrIs) are the second leading cause of hospitalization in people with spinal cord injury (SCI). The majority of PrIs occur in the community, but there is little known about prevention of community acquired PrI (CAPrI). The purpose of this study was to better understand risks, resources, and actions associated with CAPrI prevention from the perspective of veterans living with SCI in the community. METHODS A qualitative descriptive design using photovoice (n = 30) with or without guided tours (n = 15) was conducted with Veterans living with SCI at 3 sites across the United States to determine environmental/lifestyle risks at home, prevention activities, resources used, and challenges in CAPrI prevention. Interviews were audio-recorded, transcribed and analyzed using thematic analysis, followed by inductive thematic synthesis. RESULTS Qualitative analyses revealed a model describing veteran's perspective of preventing CAPrIs associated with SCI. The model included 3 themes and 9 subthemes: Factors that Lead to Risk for Pressure Injury (Challenges and Barriers), Factors that Affect Chosen Actions (Veteran Motivators, Veteran Values, Veteran Satisfaction with Provider Relationships, and Veteran Supports), and Preventive Activities within Context of Life (Physical Care, Coping, Advocacy). CONCLUSION Incorporating the veteran model of prevention within the context of life into clinical care could support provider-veteran collaboration to identify and integrate successful strategies that prevent CAPrIs while also improving veteran quality of life.
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Affiliation(s)
- Lisa Burkhart
- Center of Innovation for Complex Chronic Healthcare, Hines VA, Hines, Illinois, USA
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
| | - Lisa Skemp
- Center of Innovation for Complex Chronic Healthcare, Hines VA, Hines, Illinois, USA
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA
| | - Sameer Siddiqui
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
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Wang T, Luo C, Xie S, Tang J, He Z, Li K. Skin self-management of community-dwelling patients with spinal cord injury: A cross-sectional study. J Tissue Viability 2023:S0965-206X(23)00060-8. [PMID: 37246018 DOI: 10.1016/j.jtv.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/06/2023] [Accepted: 05/10/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND community-acquired pressure injury is one of the most common and troublesome complications of discharged patients with spinal cord injury. Previous studies have shown that pressure injury can not only increase the financial burden and care burden of patients, but also seriously affect their quality of life. AIM To evaluate the skin self-management of community-dwelling patients with spinal cord injury and to explore the related independent influencing factors. METHODS This was a cross-sectional survey study. A convenience sample of 110 community-dwelling patients with spinal cord injury recruited from three rehabilitation centers in Guangzhou and Chengdu in China completed the survey from September 2020 to June 2021. They were asked about their demographic data, skin self-management, knowledge about skin self-management, attitude to skin self-management, self-efficacy, and functional independence. Univariate analysis and multiple linear regression were performed to isolate the most important relationships. RESULTS The skin self-management of community-dwelling patients with spinal cord injury was relatively low, and they also performed poorly in the three categories of: skin check, preventing pressure ulcer, and preventing wounds. Skin self-management was found to be most often associated with level of knowledge about skin self-management, higher reimbursement and self-efficacy. CONCLUSION Community-dwelling patients with spinal cord injury with lower level of knowledge about skin self-management, with lower self-efficacy, and those with higher reimbursement have worse skin self-management.
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Affiliation(s)
- Tong Wang
- School of Nursing, Sun Yat-sen University, Guangzhou, China; Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunxiao Luo
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sumei Xie
- Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Jie Tang
- Sichuan Provincial Rehabilitation Hospital, Chengdu, China
| | - Zheng He
- Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Kun Li
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
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Rêgo ADS, Furtado GE, Bernardes RA, Santos-Costa P, Dias RA, Alves FS, Ainla A, Arruda LM, Moreira IP, Bessa J, Fangueiro R, Gomes F, Henriques M, Sousa-Silva M, Pinto AC, Bouçanova M, Sousa VIF, Tavares CJ, Barboza R, Carvalho M, Filipe L, Sousa LB, Apóstolo JA, Parreira P, Salgueiro-Oliveira A. Development of Smart Clothing to Prevent Pressure Injuries in Bedridden Persons and/or with Severely Impaired Mobility: 4NoPressure Research Protocol. Healthcare (Basel) 2023; 11:healthcare11101361. [PMID: 37239647 DOI: 10.3390/healthcare11101361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/25/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Pressure injuries (PIs) are a major public health problem and can be used as quality-of-care indicators. An incipient development in the field of medical devices takes the form of Smart Health Textiles, which can possess innovative properties such as thermoregulation, sensing, and antibacterial control. This protocol aims to describe the process for the development of a new type of smart clothing for individuals with reduced mobility and/or who are bedridden in order to prevent PIs. This paper's main purpose is to present the eight phases of the project, each consisting of tasks in specific phases: (i) product and process requirements and specifications; (ii and iii) study of the fibrous structure technology, textiles, and design; (iv and v) investigation of the sensor technology with respect to pressure, temperature, humidity, and bioactive properties; (vi and vii) production layout and adaptations in the manufacturing process; (viii) clinical trial. This project will introduce a new structural system and design for smart clothing to prevent PIs. New materials and architectures will be studied that provide better pressure relief, thermo-physiological control of the cutaneous microclimate, and personalisation of care.
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Affiliation(s)
- Anderson da Silva Rêgo
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - Guilherme Eustáquio Furtado
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
- Polytechnic Institute of Coimbra, Applied Research Institute, Rua da Misericórdia, Lagar dos Cortiços-S. Martinho do Bispo, 3045-093 Coimbra, Portugal
| | - Rafael A Bernardes
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - Paulo Santos-Costa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - Rosana A Dias
- International Iberian Laboratory of Nanotechnology (INL), 4715-330 Braga, Portugal
| | - Filipe S Alves
- International Iberian Laboratory of Nanotechnology (INL), 4715-330 Braga, Portugal
| | - Alar Ainla
- International Iberian Laboratory of Nanotechnology (INL), 4715-330 Braga, Portugal
| | - Luisa M Arruda
- Fibrenamics, Institute of Innovation on Fibre-Based Materials and Composites, University of Minho, 4800-058 Guimaraes, Portugal
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal
| | - Inês P Moreira
- Fibrenamics, Institute of Innovation on Fibre-Based Materials and Composites, University of Minho, 4800-058 Guimaraes, Portugal
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal
| | - João Bessa
- Fibrenamics, Institute of Innovation on Fibre-Based Materials and Composites, University of Minho, 4800-058 Guimaraes, Portugal
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal
| | - Raul Fangueiro
- Fibrenamics, Institute of Innovation on Fibre-Based Materials and Composites, University of Minho, 4800-058 Guimaraes, Portugal
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal
| | - Fernanda Gomes
- CEB-Centre of Biological Engineering, LIBRO-Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal
- LABBELS-Associate Laboratory, 4710-057 Braga, Portugal
| | - Mariana Henriques
- CEB-Centre of Biological Engineering, LIBRO-Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal
- LABBELS-Associate Laboratory, 4710-057 Braga, Portugal
| | - Maria Sousa-Silva
- CEB-Centre of Biological Engineering, LIBRO-Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal
- LABBELS-Associate Laboratory, 4710-057 Braga, Portugal
| | - Alexandra C Pinto
- CEB-Centre of Biological Engineering, LIBRO-Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal
- LABBELS-Associate Laboratory, 4710-057 Braga, Portugal
| | - Maria Bouçanova
- Impetus Portugal-Têxteis Sa (IMPETUS), 4740-696 Barcelos, Portugal
| | - Vânia Isabel Fernande Sousa
- Physics Center of Minho and Porto Universities (CF-UM-PT), Campus of Azurém, University of Minho, 4804-533 Guimarães, Portugal
| | - Carlos José Tavares
- Physics Center of Minho and Porto Universities (CF-UM-PT), Campus of Azurém, University of Minho, 4804-533 Guimarães, Portugal
| | - Rochelne Barboza
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal
| | - Miguel Carvalho
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal
| | - Luísa Filipe
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - Liliana B Sousa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - João A Apóstolo
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - Pedro Parreira
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
| | - Anabela Salgueiro-Oliveira
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal
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Engelen M, van Dulmen S, Vermeulen H, de Laat E, van Gaal B. The content and effectiveness of self-management support interventions for people at risk of pressure ulcers: A systematic review. Int J Nurs Stud 2021; 122:104014. [PMID: 34274772 DOI: 10.1016/j.ijnurstu.2021.104014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pressure ulcers are a common complication with a high impact on well-being and quality of life in people with impaired mobility and/or dysfunctional pain sensations. Prevention is therefore crucial. However, persons at risk seem to experience difficulties in adhering to self-management regimens that can help to prevent or diminish the development of pressure ulcers. Self-management support interventions might help to improve their self-management skills. OBJECTIVES To review the content, components and effectiveness of self-management support interventions on clinical and behavioral outcomes for people at risk of pressure ulcers. METHODS A systematic literature search for the period of January 2000 to February 2020 was conducted in five databases (CINAHL, Cochrane, PsycINFO, PubMed, and Web of Science). Inclusion criteria were: (1) studies including persons at a high risk of pressure ulcers; (2) studies investigating interventions focused on self-management support; (3) studies describing clinical and behavioral outcomes related to prevention and care of pressure ulcers. All studies were independently screened on title, abstracts and full text by two researchers. The PRISMS taxonomy of 14 components was used to code intervention content. RESULTS The search yielded 5297 papers, which resulted in the inclusion of 16 papers on self-management support interventions for persons at risk of pressure ulcers. Interventions focused mostly on 'Information about condition and/or management' (13 interventions), 'Training in practical self-management activities' (7 interventions), and 'Training in psychological strategies' (6 interventions). 'Provision of equipment' was not investigated. The intensity of the interventions varied in delivery mode, frequency and duration. Improvements were found in clinical outcomes in four studies and in behavioral outcomes in ten studies. Four studies showed improvements in clinical outcomes and ten studies in behavioral outcomes. Knowledge was positively influenced in eight studies. CONCLUSION Self-management support interventions show potential. The extensiveness and intensity of the interventions seem to be predictive for the effectiveness, but specific content components cannot be recommended. This review revealed recommendations for future research and international consensus should be reached about patient-relevant outcomes.
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Affiliation(s)
- Marscha Engelen
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.
| | - Sandra van Dulmen
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands; Nivel (Netherlands institute for health services research), Utrecht, The Netherlands.
| | - Hester Vermeulen
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands; HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands.
| | - Erik de Laat
- Radboud university medical center, Department of Plastic Surgery, The Netherlands.
| | - Betsie van Gaal
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands; HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands.
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Le Fort M, Lefèvre C, Kieny P, Perrouin-Verbe B, Ravaud JF. The functioning of social support in long-term prevention after spinal cord injury. A qualitative study. Ann Phys Rehabil Med 2020; 64:101454. [PMID: 33189942 DOI: 10.1016/j.rehab.2020.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 09/23/2020] [Accepted: 10/12/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The impact of social support on the long-term condition after a spinal cord injury (SCI) varies across studies mainly involving self-report questionnaires. OBJECTIVE We aimed to establish the common factors associated with social support leading individuals with an SCI to the effective prevention of secondary complications, including via adherence to medical follow-up. METHODS Inclusion criteria were a history of acquired SCI of any etiology, wheelchair use, and age≥18 years at the time of the study. Participants should have completed their initial rehabilitation program in France≥1 year earlier and were also enrolled according to 2 related study variables: routine medical follow-up (patients were or were not followed up) and the medically supervised reporting of a pressure ulcer after the initial rehabilitation session (0 or≥1 pressure ulcers). We performed a preparatory quantitative and qualitative literature review to identify factors affecting long-term follow-up after SCI, then adopted a narrative design with semi-structured interviews, transcribed and analyzed progressively by using qualitative analysis software. RESULTS We included 32 participants. We categorized our results based on the knowledge, attitudes, beliefs and practices of participants with respect to pressure ulcer prevention and long-term medical follow-up. Our narrative approach allowed us to identify 3 main domains relevant to social support: reciprocity, self-management and timing related to social support. CONCLUSIONS Our study showed social support as a dynamic process, a reciprocal phenomenon evolving in variations over time. These findings should be central to short- and long-term therapeutic education programs for patients and for people providing social support. Effective changes should also be implemented through the concept of the Learning Health System.
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Affiliation(s)
- Marc Le Fort
- Neurological PMR department, university hospital, 85, rue Saint-Jacques, 44093 Nantes cedex, France; House of social sciences in disability, School of advanced studies in Public Health (EHESP), 15, avenue du Professeur Léon-Bernard, 35043 Rennes, France.
| | - Chloé Lefèvre
- Neurological PMR department, university hospital, 85, rue Saint-Jacques, 44093 Nantes cedex, France.
| | - Pierre Kieny
- Neurological PMR department, university hospital, 85, rue Saint-Jacques, 44093 Nantes cedex, France.
| | - Brigitte Perrouin-Verbe
- Neurological PMR department, university hospital, 85, rue Saint-Jacques, 44093 Nantes cedex, France.
| | - Jean-François Ravaud
- House of social sciences in disability, School of advanced studies in Public Health (EHESP), 15, avenue du Professeur Léon-Bernard, 35043 Rennes, France; National Institute for Health and Medical research (Inserm), 101, rue de Tolbiac, 75654 Paris cedex 13, France.
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Gourlan M, Pellechia A, Robineau S, Foulon B, Gault D, Lefort M, Goossens D, Mathieu S, Laffont I, Dupeyron A, Ninot G, Gelis A. "What pressure ulcers mean to me?" Representations of pressure ulcer in persons with spinal cord injury: A qualitative study. J Tissue Viability 2020; 29:324-330. [PMID: 32830010 DOI: 10.1016/j.jtv.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Explore the perceptions and beliefs related to pressure ulcers (PU), their prevention and treatment strategies, in order to discuss potential learning objectives for PU-related therapeutic education in persons with spinal cord injury (SCI). DESIGN Qualitative study, using grounded theory for the analysis of data collected via a questionnaire. SETTING Nine SCI referral centers, inpatient care. PARTICIPANTS 131 persons with SCI were included. 76% were male, and 65% presented with paraplegia. The median age was 48 years (33.5; 58) and median time since injury was 11 years (3; 24.5). 70% had experience with PU. INTERVENTIONS None. MAIN OUTCOME MEASURES Data collection via an open-ended questionnaire on the representation of PU, its prevention and life experience of having a PU. RESULTS Six categories were identified: (1) identifying what might become problematic, (2) daily preventive actions, (3) detecting the early signs, (4) managing the early signs, (5) need for care, (6) experience with PU and being bedridden. Pressure ulcers have dramatic consequences on psychosocial health. Prevention and treatment require self-management skills, such as self-risk assessment abilities, self-detection skills and problem-solving strategies, to optimise daily PU prevention in persons with SCI. CONCLUSION PU prevention tackled by persons with SCI bears some specificities that the physician must take into account in the construction of a self-management program in this high-risk population.
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Affiliation(s)
- Mathieu Gourlan
- Laboratoire Epsylon EA 4556, Université de Montpellier, University, Rue Henri Serre, Montpellier, France
| | - Alessandra Pellechia
- Unité Transversale D'éducation Du Patient (UTEP), CHU Montpellier, Hôpital La Colombière, 39 Avenue Charles Flahault, 34295, Montpellier, Cedex 5, France
| | - Sandrine Robineau
- Pôle de Médecine Physique et de Réadaptation Saint Helier, 54 Rue Saint Helier, Rennes, France
| | - Bernard Foulon
- Association des Paralysés de France, 1620 Rue de Saint Priest, 34090, Montpellier, France
| | - Dominique Gault
- Centre de Rééducation Clemenceau, 45 Boulevard Clemenceau, 67000, Strasbourg, France
| | - Marc Lefort
- Département de Médecine Physique et de Réadaptation, CHU Saint Jacques, 85 Rue Saint-Jacques, 44093, Nantes, France
| | - David Goossens
- Centre de Rééducation de La Tour de Gassies, 33520, Bruges, France
| | - Sarah Mathieu
- Centre de Rééducation Fonctionnelle de Kerpape, Ploemeur, 92 Rue de L'Anse Du Stole, 56270, France
| | - Isabelle Laffont
- Département de Médecine Physique et de Réadaptation, CHU Lapeyronie, 371 Avenue Du Doyen Gaston GIRAUD, Montpellier, France
| | - Arnaud Dupeyron
- Département de Médecine Physique et de Réadaptation, CHU Caremeau, 4 Rue Du Pr Debré, Nîmes, France
| | - Gregory Ninot
- Laboratoire Epsylon EA 4556, Université de Montpellier, University, Rue Henri Serre, Montpellier, France
| | - Anthony Gelis
- Laboratoire Epsylon EA 4556, Université de Montpellier, University, Rue Henri Serre, Montpellier, France; Département de Médecine Physique et de Réadaptation, CHU Lapeyronie, 371 Avenue Du Doyen Gaston GIRAUD, Montpellier, France; Centre Mutualiste Neurologique PROPARA, 263 Rue Du Caducée, Montpellier, France.
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Eysenbach G, Fiordelli M, Brach M, Bertschy S, Scheel-Sailer A, Rubinelli S. Co-designing a Self-Management App Prototype to Support People With Spinal Cord Injury in the Prevention of Pressure Injuries: Mixed Methods Study. JMIR Mhealth Uhealth 2020; 8:e18018. [PMID: 32673241 PMCID: PMC7380902 DOI: 10.2196/18018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/03/2020] [Accepted: 04/19/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Spinal cord injury is a complex chronic health condition that requires individuals to actively self-manage. Therefore, an evidence-based, self-management app would be of value to support individuals with spinal cord injury in the prevention of pressure injuries. OBJECTIVE The main objectives of this study were to (1) establish a co-design approach for developing a high-fidelity prototype app for the self-management of individuals with spinal cord injury, (2) design the prototype that resulted from this process, and (3) conduct the first usability assessment of the prototype app. METHODS We adopted a co-design approach to develop an evidence-based app prototype. Starting from a preliminary content model (based on clinical guidelines for the prevention of pressure injuries) and three research-based user personas, we conducted an ideation workshop involving individuals with spinal cord injury and health care professionals. The ideation workshop formed the basis for two consecutive design sprints. The result of this co-design phase was an interactive app prototype. The prototype was evaluated in two rounds of usability testing (N=4 and N=15, respectively) using a combination of qualitative and quantitative methods. RESULTS The co-design process resulted in a high-fidelity prototype with two key components: a self-management component and a communication component. The final prototype included a combination of features to support individuals with spinal cord injury in the prevention of pressure injuries, namely a smart camera, pressure injury diary, expert consultation, reminders, and knowledge repository. Findings of the usability testing showed that most participants navigated the app fluently with little back and forth navigation and were able to successfully complete a set of assigned tasks. These positive results are supported by the average system usability score achieved (78.5/100; range 47.5-95.0) and our qualitative analysis of the semistructured interviews. Despite an overall positive evaluation of the app prototype, we identified areas for improvement (eg, inclusion of a search function). CONCLUSIONS Individuals with spinal cord injury often need to navigate competing interests and priorities, paired with uncertainty about the accuracy and relevance of clinical recommendations. Understanding what matters to individuals with spinal cord injury can help guide the design of behavioral interventions that are useful and acceptable to these individuals in their daily lives. This study shows that involving individuals with spinal cord injury and health care professionals in co-designing a self-management app can foster knowledge cocreation at the intersection of lived experience, medical expertise, and technical solutions.
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Affiliation(s)
| | - Maddalena Fiordelli
- Swiss Paraplegic Research, Nottwil, Switzerland.,Institute of Communication and Health, University of Lugano, Lugano, Switzerland
| | - Mirjam Brach
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne, Switzerland
| | - Sue Bertschy
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne, Switzerland
| | | | - Sara Rubinelli
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne, Switzerland
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Harvey LA. Looking back on 2019. Spinal Cord 2019; 57:999-1000. [PMID: 31811264 DOI: 10.1038/s41393-019-0362-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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11
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Self-management interventions for skin care in people with a spinal cord injury: part 2-a systematic review of use of theory and quality of intervention reporting. Spinal Cord 2018; 56:837-846. [PMID: 29795415 PMCID: PMC6128816 DOI: 10.1038/s41393-018-0136-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 03/18/2018] [Accepted: 03/20/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVES To examine use of theory and quality of reporting in skin care self-management interventions for people with SCI. SETTING International. METHODS The Theory Coding Scheme (TCS) and the Template for Intervention Description and Replication (TIDieR) checklist were applied by two independent researchers to 17 interventions identified in a systematic review of self-management interventions for skin care in people with SCI. RESULTS Six (35%) of the 17 interventions reviewed were reported to have a theoretical basis. Theories used included three of the most commonly featured in health behavior research (the Health Belief Model, Social Cognitive Theory, and the Transtheoretical Model). In these six interventions, theory was used to design content but not to select participants or tailor strategies. None of the interventions were used to test theories in the SCI population, or to propose theoretical refinements. Reporting quality was found to vary by TIDieR item, with 6-100% of interventions including recommended information. Information on two intervention fidelity items was missing in 53 and 82% of descriptions. CONCLUSIONS Use of theory and reporting quality in SCI self-management research remains suboptimal, potentially slowing down advancements in this area of research. Rehabilitation researchers should direct their efforts toward improving these practices to help build a science of SCI self-management that is cumulative and reproducible by clinicians, scientists, and policy makers. SPONSORSHIP This work was funded through a postdoctoral fellowship awarded to the first author by the Rick Hansen Institute.
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