Pressure Injury Data Reconciliation in a Randomized Controlled Trial.

Objective: To advance pressure injury (PrI) research in individuals with spinal cord injury (SCI) by describing lessons learned and recommendations for future research, ultimately promoting PrI prevention and more effective wound care. This paper describes the detailed procedures undertaken to collect and reconcile PrI data and summarizes the types of discrepancies identified.

Design: Secondary analyses of PrI data collected between 2009 and 2014 in a randomized controlled trial (parent study).

Nurturing the Prepared Mind: Research During Level II Fieldwork.

Importance: Level II fieldwork is one of the last opportunities for students to learn from clinicians modeling how to gather practice-based data for research before independent practice.

Objective: To identify options for incorporating active research opportunities in the Level II fieldwork experience and the barriers that preclude these opportunities.

Design: Approximately 575 electronic surveys (QuestionPro), consisting of 31 questions, distributed to fieldwork sites.

Factors Protecting Against Pressure Injuries in Medically Underserved Adults With Spinal Cord Injury: A Qualitative Study.

Pressure injuries negatively impact quality of life and participation for individuals with spinal cord injury (SCI). To examine the factors that may protect against the development of medically serious pressure injuries in adults with SCI. A qualitative analysis was conducted using treatment notes regarding 50 socioeconomically disadvantaged individuals who did not develop medically serious pressure injuries during a 12-month pressure injury prevention intervention program.

A qualitative analysis of pressure injury development among medically underserved adults with spinal cord injury.

Medically underserved adults with spinal cord injury (SCI) remain at high risk of incurring medically serious pressure injuries even after receiving education in prevention techniques. The purpose of this research is to identify circumstances leading to medically serious pressure injury development in medically underserved adults with SCI during a lifestyle-based pressure injury prevention program, and provide recommendations for future rehabilitation approaches and intervention design. This study entailed a qualitative secondary case analysis of treatment notes from a randomized controlled trial.

Lifestyle intervention for adults with spinal cord injury: Results of the USC-RLANRC Pressure Ulcer Prevention Study.

Context/objective: Medically serious pressure injuries (MSPrIs), a common complication of spinal cord injury (SCI), have devastating consequences on health and well-being and are extremely expensive to treat. We aimed to test the efficacy of a lifestyle-based intervention designed to reduce incidence of MSPrIs in adults with SCI.

Design: A randomized controlled trial (RCT), and a separate study wing involving a nonrandomized standard care control group.

The Prepared Mind.

Every day, in clinics and hospitals around the world, occupational therapists care for patients with serious problems requiring viable solutions. Each patient is unique, and his or her problem does not necessarily correspond to existing practice models. Practitioners must adapt standard approaches to provide effective outcomes, yet problems exist for which few or no beneficial approaches have been identified.

Systematic review of behavioral and educational interventions to prevent pressure ulcers in adults with spinal cord injury.

Objective: To investigate the efficacy of behavioral or educational interventions in preventing pressure ulcers in community-dwelling adults with spinal cord injury (SCI).

Data Sources: Cochrane, Clinical Trials, PubMed, and Web of Science were searched in June 2016. The search combined related terms for pressure ulcers, spinal cord injury, and behavioral intervention.

Predictive validity of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) in acute care and inpatient rehabilitation in individuals with traumatic spinal cord injury.

Objective: To evaluate the validity of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) during acute care and inpatient rehabilitation following spinal cord injury (SCI) by determining critical cutoff points and assessing the ability to predict risk for pressure ulceration (PrU).

Design: Retrospective.

Methods: Sensitivity, specificity, and area under the curve (AUC) for the receiver operating characteristic were determined for the scale's ability to predict PrU 2-3 and 5-7 days after administrating the SCIPUS during acute care, and 5-7 and 14-21 days after administrating the SCIPUS during inpatient rehabilitation.

Utilization and user satisfaction with alternating pressure air cushions: a pilot study of at-risk individuals with spinal cord injury.

Purpose: An appropriate wheelchair cushion is integral to pressure ulcer (PU) prevention for the wheelchair user with SCI. For users who find it difficult to remember or perform weight shifts, an alternating pressure air cushion (APAC) may off-load pressure to minimize PU risk. APACs are considered mobility assistive technology (AT).

Implementing trials of complex interventions in community settings: the USC-Rancho Los Amigos pressure ulcer prevention study (PUPS).

Background: Randomized trials of complex, non-pharmacologic interventions implemented in home and community settings, such as the University of Southern California (USC)-Rancho Los Amigos National Rehabilitation Center (RLANRC) Pressure Ulcer Prevention Study (PUPS), present unique challenges with respect to (1) participant recruitment and retention, (2) intervention delivery and fidelity, (3) randomization and assessment, and (4) potential inadvertent treatment effects.

Purpose: We describe the methods employed to address the challenges confronted in implementing PUPS. In this randomized controlled trial, we are assessing the efficacy of a complex, preventive intervention in reducing the incidence of, and costs associated with, the development of medically serious pressure ulcers in people with spinal cord injury.

Conducting intervention research among underserved populations: lessons learned and recommendations for researchers.

Randomized controlled trials (RCTs) are considered the criterion standard in research design for establishing treatment efficacy. However, the rigorous and highly controlled conditions of RCTs can be difficult to attain when conducting research among individuals living with a confluence of disability, low socioeconomic status, and being a member of a racial/ethnic minority group, who may be more likely to have unstable life circumstances. Research on effective interventions for these groups is urgently needed, because evidence regarding approaches to reduce health disparities and improve health outcomes is lacking.

Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial.

This randomized, controlled, multisite Department of Veterans Affairs clinical trial assessed robot-assisted (RA) upper-limb therapy with the Mirror Image Movement Enabler (MIME) in the acute stroke rehabilitation setting. Hemiparetic subjects (n = 54) received RA therapy using MIME for either up to 15 hours (low-dose) or 30 hours (high-dose) or received up to 15 hours of additional conventional therapy in addition to usual care (control). The primary outcome measure was the Fugl-Meyer Assessment (FMA).

Therapists' roles in pressure ulcer management in persons with spinal cord injury.

Background: Among veterans with spinal cord injury (SCI), severe pressure ulcers (PrU) are treated by interdisciplinary rehabilitation teams in SCI units.

Method: Cross-sectional survey administered to therapists attending a conference of the Therapy Leadership Council in SCI.

Participants: Respondents included physical therapists (PTs; n=24) and occupational therapists (OTs; n=15).

Characteristics of recurrent pressure ulcers in veterans with spinal cord injury.

Background/objective: To describe characteristics of recurrent pressure ulcers (PrUs) in veterans with spinal cord injury (SCI).

Design: Descriptive, cohort study.

Settings And Participants: Twenty-four veterans with SCI from 6 SCI centers in the Department of Veterans Affairs.

Predictors of pressure ulcer recurrence in veterans with spinal cord injury.

Background/objective: To predict recurrence of pressure ulcers (PrUs) in a high-risk population of veterans with spinal cord injury (SCI).

Design: Cross-sectional observational design.

Participants: A convenience sample of 64 subjects from 6 Department of Veterans Affairs (VA) SCI Centers who had been admitted to the hospital for the treatment of stage III-IV pelvic PrUs and were healed at the time of discharge back to the community.

Factors predicting pressure ulcers in veterans with spinal cord injuries.

Objectives: To identify patient risk factors for pressure ulcers in a sample of veterans with spinal cord injuries and disorders.

Design: A survey incorporating questions from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System was mailed to individuals with spinal cord injuries and disorders in 2003. A multiple logistic regression model including 2574 respondents was used to examine the association between patient characteristics and the self-report of pressure ulcers.

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

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.

Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy.

Objective: To show fatigue prevention and quality of life (QOL) improvement from cardiovascular exercise during radiotherapy.

Design: Prospective enrollment (n=21), randomized to exercise (n=11) and control groups (n=10), with pre- and post-radiotherapy between- and within-group comparisons.

Setting: Academic medical center.

A structured educational model to improve pressure ulcer prevention knowledge in veterans with spinal cord dysfunction.

Objective: This paper describes an educational model for increasing and retaining the knowledge of pressure ulcer prevention and management in veterans with spinal cord injury (SCI) or multiple sclerosis (MS) who have had surgical repair of a pressure ulcer. It also describes the correlates of pressure ulcer knowledge at admission and discharge.

Methods: Before pressure ulcer surgery, 41 male veterans with SCI or MS were randomized to either an intervention group or a control group.

Wheelchair utilization and satisfaction following cerebral vascular accident.

The purpose of this cross-sectional descriptive study was to determine the extent to which wheelchairs prescribed during rehabilitation are used and perceived as satisfactorily meeting individual mobility, functional, psychological and social needs of veterans who have had a stroke. Forty-nine veterans were interviewed during a one-time visit to the Veterans Affairs Medical Center. Questionnaires on demographics, medical status, functional independence, cognition, social integration, depression, health status and well-being, and wheelchair use and satisfaction were administered.

Lessons learned while conducting research on prevention of pressure ulcers in veterans with spinal cord injury.

Objective: To describe the challenges of conducting a large randomized controlled trial (RCT) to assess the effectiveness of an intervention to prevent recurrent pressure ulcers among a high-risk population of subjects with spinal cord injury (SCI).

Design: Prospective multisite, randomized design comparing outcomes of patients who received individualized education and structured telephone counseling follow-up with those of patients receiving customary care. This study was stopped early because of unanticipated recruitment problems.

Association of hemoglobin levels, acute hemoglobin decrease, age, and co-morbidities with rehabilitation outcomes after total knee replacement.

Objective: A study was undertaken to assess the association of preoperative and postoperative hemoglobin levels with rehabilitation outcomes, age, and selected co-morbidities

Design: Charts of 49 patients admitted to rehabilitation after total knee arthroplasty due to degenerative joint disease were reviewed. Outcome measures included rehabilitation admission and discharge motor FIMtrade mark scores, motor FIM gain, and rehabilitation length of stay.

Results: Patients with higher preoperative hemoglobin levels had higher rehabilitation admission motor FIM scores (r=0.

Telerehabilitation for veterans with a lower-limb amputation or ulcer: Technical acceptability of data.

A study was undertaken to determine the technical acceptability of information available via a customized telerehabilitation system regarding patients with lower-limb ulcers or recent lower-limb amputations receiving care at a Veterans Affairs Medical Center. Among the 54 participants, 57 wounds (39 ulcers, 19 amputation incisions) were evaluated by means of still photographs and skin temperature data sent via ordinary telephone lines. Three experienced clinicians served as raters.

Pressure ulcers in veterans with spinal cord injury: a retrospective study.

Pressure ulcers are a major complication of spinal cord injury (SCI) and have a significant effect on general health and quality of life. The objectives of this retrospective chart review were to determine prevalence, duration, and severity of pressure ulcers in veterans with SCI and to identify predictors of (1) outcome in terms of healing without surgery, not healing, or referral for surgery; (2) number of visits veterans made to the SCI outpatient clinic or received from home care services for pressure ulcer treatment; and (3) number of hospital admissions and days hospitalized for pressure ulcer treatment. From a sampling frame of 553 veterans on the Houston Veterans Affairs Medical Center SCI roster, 215 (39%) were reported to have visited the clinic or received home care for pressure ulcers (ICD-9 code 707.