1
|
Burkhart L, Siddiqui S, Smith A, Richardson M, Zachow K, Chua W, Weaver FM, Skemp L, Kiefer A, LaVela SL, Bates-Jensen B. Development of a decision support tool to prevent community acquired pressure injuries for use in the spinal cord injury clinic using the delphi technique. Spinal Cord 2023; 61:667-683. [PMID: 37828368 DOI: 10.1038/s41393-023-00937-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023]
Abstract
STUDY DESIGN Delphi Technique. OBJECTIVES Describe the development of a decision support tool to prevent community-acquired pressure injuries (CAPrIs) in individuals with spinal cord injury (SCI) for use in SCI clinics, called the Community-Acquired Pressure Injury Prevention-Field Implementation Tool (CAPP-FIT). SETTING Veteran Health Administration Hospital, Chicago, Illinois, USA. METHODS Concept mapping of current pressure injury (PrI) guidelines and qualitative research describing risks, actions, and resources needed to prevent CAPrIs associated with SCI were used to develop 40 veteran checklist items (Items) along with 37 associated provider actions (Actions) for the tool. The Delphi technique was used to refine Items and Actions with a panel of interprofessional SCI providers (n = 15), veterans with SCI (n = 4), and caregivers (n = 3) to determine consensus on a 4-point Likert scale (strongly agree-strongly disagree) for each Item and Action. A 75% agreement was set for responses rated as strongly agree or agree. RESULTS Panelists were 60% female, 62% White, 33% veterans with SCI or caregivers, 33% wound care certified with a mean age of 59 years. Two survey rounds were required for consensus for 41 Item and 38 Action CAPP-FIT. Response rate was 95% for both rounds. Delphi round 1 showed all but two Actions affirming agreement above 75%. Substantive comments from panelists required revision to 5 Items and 9 Actions and one additional Item/Actions related to coping, meeting threshold percent agreement in Round 2. CONCLUSIONS The CAPP-FIT could become a useful tool for Veterans living with SCI, caregivers, and SCI providers.
Collapse
Affiliation(s)
- Lisa Burkhart
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA.
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA.
| | - Sameer Siddiqui
- Spinal Cord Injury Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Autumn Smith
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | | | | | - Walter Chua
- Spinal Cord Injury and Disorders Health Care Group (HCG) and Surgery HCG, VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Lisa Skemp
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Amy Kiefer
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| | - Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Barbara Bates-Jensen
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
- Division of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
2
|
Silva GGD, Britz JPE, Martins OG, Ferreira NP, Ferreira MP, Worm PV. IMPACT OF SURGERY ON AMBULATORY STATUS IN PATIENTS WITH SYMPTOMATIC NEOPLASTIC SPINAL CORD COMPRESSION IN SOUTHERN BRAZIL. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222103263573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Background: Spinal cord compression is a common complication of spine metastasis and multiple myeloma. About 30% of patients with cancer develop symptomatic spinal metastases during their illness. Prompt diagnosis and surgical treatment of these lesions, although palliative, are likely to reduce the morbidity and improve quality of life by improving ambulatory function. Study Design: Retrospective review of medical records. Objective: To evaluate postoperative functional recovery and the epidemiological profile of neoplastic spinal cord compression in two neurosurgical centers in southern Brazil. Methods: We retrospectively analyzed the data of all patients who underwent palliative surgery for symptomatic neoplastic spine lesion from metastatic cancer, in two neurosurgical centers, between January 2003 and July 2021. The variables age, sex, neurological status, histological type, affected segment, complications and length of hospitalization were analyzed. Results: A total of 82 patients were included. The lesions occurred in the thoracic spine in 60 cases. At admission, 95% of the patients had neurological deficits, most of which were Frankel C (37%). At histopathological analysis, breast cancer was the most common primary site. After surgery, the neurological status of 46 patients (56%) was reclassified according to the Frankel scale. Of these, 22 (47%) regained ambulatory capacity. Conclusion: Surgical treatment of metastatic spinal cord compression improved neurological status and ambulatory ability in our sample. Level of evidence II; Retrospective study.
Collapse
|
3
|
Development of the spinal cord injury pressure sore onset risk screening (SCI-PreSORS) instrument: a pressure injury risk decision tree for spinal cord injury rehabilitation. Spinal Cord 2020; 59:123-131. [PMID: 32694750 DOI: 10.1038/s41393-020-0510-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Psychometric study based on retrospectively collected data. OBJECTIVE Development of a pressure injury (PI) risk screening instrument for use during spinal cord injury (SCI) rehabilitation. SETTING Tertiary rehabilitation center. METHODS Medical charts of 807 inpatients participating in SCI rehabilitation were reviewed. Two models (recursive partitioning and logistic regression) were developed with demographic and Functional Independence Measure (FIM) variables and compared with the SCI Pressure Ulcer Scale (SCIPUS, n = 603) and Braden scale (n = 100) using modeling (n = 615) and validation (n = 192) datasets. Sensitivity and specificity analyses were completed for each model. Models yielding high sensitivity and area under the curve (AUC), while minimizing false negatives (FN < 0.5%) were preferred. RESULTS In the modeling dataset, a single dichotomized FIM variable, Bed/Chair Transfers <4, was predictive of PI incidence (sensitivity = 97%, AUC = 74%, FN = 0.49%) and had similar metrics as the logistic regression model (sensitivity = 97%, AUC = 76%, FN = 0.49%). The recursive partitioning model had fewer FN (sensitivity = 98%, AUC = 75%, FN = 0.33%). When applied to the validation dataset, both models performed similarly. The SCIPUS performed poorly (AUC < 70%). When analyses were limited to cases with available Braden data and no admission PI, recursive partitioning outperformed the other methods for PI risk screening. CONCLUSION A recursive partitioning model, named the SCI-PreSORS (SCI Pressure Sore Onset Risk Screening), demonstrated promise for PI risk screening during inpatient SCI rehabilitation. Prospective validation of the new model is warranted.
Collapse
|
4
|
Tomaschek R, Gemperli A, Rupp R, Geng V, Scheel-Sailer A. A systematic review of outcome measures in initial rehabilitation of individuals with newly acquired spinal cord injury: providing evidence for clinical practice guidelines. Eur J Phys Rehabil Med 2019; 55:605-617. [DOI: 10.23736/s1973-9087.19.05676-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
5
|
Gould LJ, Bohn G, Bryant R, Paine T, Couch K, Cowan L, McFarland F, Simman R. Pressure ulcer summit 2018: An interdisciplinary approach to improve our understanding of the risk of pressure‐induced tissue damage. Wound Repair Regen 2019; 27:497-508. [DOI: 10.1111/wrr.12730] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/12/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Lisa J. Gould
- South Shore Hospital Center for Wound Healing Weymouth Massachusetts
| | | | - Ruth Bryant
- Abbott Northwestern Hospital Minneapolis Minnesota
| | - Tim Paine
- Department of RehabilitationLitchfield Hills Orthopedic Torrington Connecticut
| | - Kara Couch
- Wound Healing and Limb Preservation CenterGeorge Washington University Hospital Washington District of Columbia
| | - Linda Cowan
- Center of Innovation on Disability and Rehabilitation ResearchVirginia Health Care Richmond Virginia
| | | | - Richard Simman
- Jobst Vascular InstituteUniversity of Toledo College of Medicine Toledo Ohio
| |
Collapse
|
6
|
Higgins J, Laramée MT, Harrison KR, Delparte JJ, Scovil CY, Flett HM, Burns AS. The Spinal Cord Injury Pressure Ulcer Scale (SCIPUS): an assessment of validity using Rasch analysis. Spinal Cord 2019; 57:874-880. [PMID: 31053776 DOI: 10.1038/s41393-019-0287-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Secondary analysis of retrospective data. OBJECTIVE The aim of this study was to further validate the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) using Rasch analysis. SETTING Two rehabilitation centers in Canada. METHOD Data were collected as part of the Spinal Cord Injury Knowledge Mobilization Network (SCI KMN) initiative. The SCIPUS was completed within 72 h of inpatient admission. Persons admitted for initial rehabilitation in two inpatient spinal cord rehabilitation programs were included in the project. RESULTS Data from 886 participants were analyzed, approximately 60% of whom were males. Rasch analyses demonstrated that the SCIPUS, in its current format did not meet criteria required for true measurement. A transformed version of the SCIPUS obtained by deletion of misfitting items and modification of the response scales improved fit to the model and showed preliminary evidence of unidimensionality. The person separation index, however indicated that the scale requires further adjustments of its scoring options. CONCLUSIONS In its original form, the SCIPUS does not meet the requirements of the Rasch model and its total score should be used cautiously. However, following some adjustments to the items such as addressing DIF between sites to insure a standardized assessment across sites and adding response options to some of the items, interval-scale measurement should be possible.
Collapse
Affiliation(s)
- Johanne Higgins
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada. .,Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM) of the Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada. .,School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
| | - Marie-Thérèse Laramée
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada.,Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM) of the Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Kate Rousseau Harrison
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada.,Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM) of the Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Jude J Delparte
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Carol Y Scovil
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Heather M Flett
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Anthony S Burns
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Division of Physiatry, Department of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
7
|
Flett HM, Delparte JJ, Scovil CY, Higgins J, Laramée MT, Burns AS. Determining Pressure Injury Risk on Admission to Inpatient Spinal Cord Injury Rehabilitation: A Comparison of the FIM, Spinal Cord Injury Pressure Ulcer Scale, and Braden Scale. Arch Phys Med Rehabil 2019; 100:1881-1887. [PMID: 31054293 DOI: 10.1016/j.apmr.2019.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/27/2019] [Accepted: 04/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Assess the utility of the admission Spinal Cord Injury Pressure Ulcer Scale (SCIPUS), Braden Scale, and the FIM for identifying individuals at risk for developing pressure injury during inpatient spinal cord injury (SCI) rehabilitation. DESIGN Retrospective cohort. SETTING Two tertiary rehabilitation centers. PARTICIPANTS Individuals (N=754) participating in inpatient SCI rehabilitation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Logistic regression analysis was performed to determine the utility of the SCIPUS, Braden Scale, and FIM for identifying individuals at risk for developing pressure injury (PI) during inpatient SCI rehabilitation. Sensitivity, specificity, positive predictive value, negative predictive value, false negative rate, odds ratio, likelihood ratio, and area under the curve (AUC) are reported. RESULTS The SCIPUS total score and its individual items did not demonstrate acceptable accuracy (AUC≥0.7) whereas the Braden Scale (0.73) and the FIM score (0.74) did. Once items were dichotomized into high and low risk categories, 1 Braden item (friction and shear), 5 FIM items (bathing, toileting, bed/chair transfer, tub/shower transfer, toilet transfer), the FIM transfers subscale, FIM Motor subscale, and the FIM instrument as a whole, maintained AUCs ≥0.7 and negative predictive values ≥0.95. The FIM bed/chair transfer score demonstrated the highest likelihood ratio (2.62) and overall was the most promising measure for determining PI risk. CONCLUSION Study findings suggest that a simple measure of mobility, admission FIM bed/chair transfer score of 1 (total assist), can identify at-risk individuals with greater accuracy than both an SCI specific instrument (SCIPUS) and a PI specific instrument (Braden). The FIM bed/chair transfer score can be readily determined at rehabilitation admission with minimal administrative and clinical burden.
Collapse
Affiliation(s)
- Heather M Flett
- Brain and Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON; Department of Physical Therapy, University of Toronto, Toronto, ON.
| | - Jude J Delparte
- Brain and Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON
| | - Carol Y Scovil
- Brain and Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON
| | - Johanne Higgins
- Research Unit, Integrated University Centre for Health and Social Services for South Central Island of Montreal-Institute of Rehabilitation Gingras-Lindsay-de-Montréal, Montreal, QC; School of Rehabilitation Faculty of Medicine, University of Montreal, Montreal, QC; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC
| | - Marie-Thérèse Laramée
- Research Unit, Integrated University Centre for Health and Social Services for South Central Island of Montreal-Institute of Rehabilitation Gingras-Lindsay-de-Montréal, Montreal, QC; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC; Spinal Cord Injury Program, CCSMTL, - Institute of Rehabilitation Gingras-Lindsay-de-Montréal, Montreal, QC
| | - Anthony S Burns
- Brain and Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON; Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
8
|
Scovil CY, Delparte JJ, Walia S, Flett HM, Guy SD, Wallace M, Burns AS, Wolfe DL, Wolfe D, Kras-Dupuis A, Walia S, Guy S, Askes H, Casalino A, Fraser C, Paiva M, Miles S, Gagliardi J, Orenczuk S, Sommerdyk J, Genereaux M, Jarvis D, Wesenger J, Bloetjes L, Flett H, Burns A, Scovil C, Delparte J, Leber D, McMillan L, Domingo T, Wallace M, Stoesz B, Aguillon G, Koning C, Mumme L, Cwiklewich M, Bayless K, Crouse L, Crocker J, Erickson G, Mark M, Charbonneau R, Lloyd A, Van Doesburg C, Knox J, Wright P, Mouneimne M, Parmar R, Isaacs T, Reader J, Oga C, Birchall N, McKenzie N, Nicol S, Joly C, Laramée M, Robidoux I, Casimir M, Côté S, Lubin C, Lemay J, Beaulieu J, Truchon C, Noreau L, Lemay V, Vachon J, Bélanger D, Proteau F, O'Connell C, Savoie J, McCullum S, Brown J, Duda M, Bassett-Spiers K, Riopelle R, Hsieh J, Reinhart-McMillan W, Joshi P, Noonan V, Humphreys S, Hamilton L, MacIsaac G. Implementation of Pressure Injury Prevention Best Practices Across 6 Canadian Rehabilitation Sites: Results From the Spinal Cord Injury Knowledge Mobilization Network. Arch Phys Med Rehabil 2019; 100:327-335. [DOI: 10.1016/j.apmr.2018.07.444] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 07/11/2018] [Accepted: 07/20/2018] [Indexed: 12/19/2022]
|
9
|
Lima DKS, Schoeller SD, Knihs NDS, Vargas CP, Tholl AD, Lopes SGR, Martins MM, Hammerschmidt KSDA. Protocol for a scoping review of skin self-care of people with spinal cord injury. BMJ Open 2017; 7:e017860. [PMID: 28928196 PMCID: PMC5623548 DOI: 10.1136/bmjopen-2017-017860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In recent years, increasing methodological references have been used in scientific research; these are points of support in the search for evidence, formulation and elaboration of instruments, scales, guideline and protocols. However, significant variability currently exists in scoping review conduct and reporting, thus limiting the potential of the methodology to advance research and practice about skin self-care of people with spinal cord injury (SCI). Our objective was to perform a scoping review protocol within the health rehabilitation context of people with SCI, focusing on skin self-care. METHODS AND ANALYSIS The protocol was developed by using the scoping review methodological framework proposed by Arksey and O'Malley and further refined by the Joanna Briggs Institute, incorporating insights from more recent innovations in scoping review methodology. Sensitive searches of 13 electronic databases from 2007 to 2017 will be supplemented by grey literature searches. Two reviewers using a tool developed for this scoping review will screen eligible studies. ETHICS AND DISSEMINATION The scoping review will undertake a secondary analysis of previously collected data and does not require ethical approval; however, the ethical precepts of copyright will be respected. The results will facilitate a better understanding of the practical health rehabilitation context of people with SCI, the impacts of these rehabilitations and how to build an evidence base for this work in the future.
Collapse
Affiliation(s)
- Daniella Karine Souza Lima
- Department of Nursing, Center for Health Sciences, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Soraia Dornelles Schoeller
- Department of Nursing, Center for Health Sciences, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Neide da Silva Knihs
- Department of Nursing, Center for Health Sciences, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Caroline Porcelis Vargas
- Department of Nursing, Center for Health Sciences, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Adriana Dutra Tholl
- Department of Nursing, Center for Health Sciences, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Soraia Geraldo Rozza Lopes
- Department of Nursing, Center for Health Sciences, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | | | | |
Collapse
|