Pressure ulcer prevention education programs for individuals with SCI provide knowledge and emphasize behaviours intended to reduce the risk of pressure ulcer occurrence (Bogie 1995; Rodriguez & Garber 1994; Schubart et al. 2008).  Typically this education is delivered while the individual is an inpatient at a time when they and their family are adjusting to a diagnosis of SCI and are likely suffering from information overload.  Under these circumstances, the individuals’ ability to appreciate the knowledge and behaviours necessary to prevent pressure ulcers over their lifetime is compromised (Garber et al.1996; Schubart et al. 2008).  With shorter lengths of stay, there is less time to deliver prevention education and fewer opportunities for reinforcement of acquired knowledge.  This means that individuals with SCI are being discharged with potentially less information on pressure ulcer prevention (Garber et al.1996).  As well, there is little data on the specific education needs required by individuals with SCI at risk for pressure ulcer formation (Schubart et al 2008) (See Table 20.9).

Table: Pressure Ulcer Prevention Education Post SCI

Discussion

In an RCT conducted by Garber et al. (2002), subjects in the intervention group (n=20) while an inpatient for pressure ulcer surgery were provided with four 1-hour sessions of enhanced education on the prevention and management of pressure ulcers. Information presented at the sessions included education regarding preventative strategies such as skin inspection, weight shifts/turns, nutrition and pressure redistribution surfaces for the bed and wheelchair, as well as pressure ulcer etiology.  The control group (n=21) received standard education regarding preventative practices. After discharge, the groups were followed for 2 years or until recurrence of pelvic pressure ulcer. 

Improvement on the pressure ulcer knowledge test was noted in both groups upon discharge from hospital; however, it was significantly different between the groups (p<0.03), with those in the intervention group gaining more knowledge about preventing pressure ulcers. No significant differences were noted on the multidimensional Health Locus of Control Scale and the Health Beliefs Questionnaire between the two groups at discharge.  Two years post treatment, it was noted that both groups had retained most of the knowledge they had gained during their hospitalization, but the level of knowledge retained by the control group was below that of the treatment group: 60.8% versus 68% on the pressure ulcer knowledge test.

In a parallel study, Rintala et al. (2008), randomized the same subjects into three groups: Group 1 (N=20) had received the enhanced education sessions. They were followed through structured monthly telephone contact where they were questioned regarding skin status, pressure ulcer preventative behaviors and reminded of behaviors they were not using. Group 2 (N=11) were contacted monthly by mail to assess skin status only and Group 3 (n=10) were contacted every 3 months by mail to assess skin status. If those in groups 2 and 3 had not responded in 2 weeks, they were contacted by telephone. Group 1 had a significantly longer time before recurrence of pressure ulcers (19.6 months, p=0.002) while no significant difference was seen between group 2 or 3. For persons who had not had previous pressure ulcer surgery, the enhanced education and structured follow-ups extended their ulcer free time. As well, less people in group 1 had a recurrence of a pressure ulcer (33.3%) versus group 2 (60%) and group 3 (90%).

In summary, those individuals who received an enhanced education and structured follow-up, showed more improvement on the pressure ulcer knowledge test at discharge, retained more of this knowledge 2 years post intervention and had fewer recurrences of pressure ulcers. For those individuals who went on to have a recurrence, time to recurrence was much longer.

Conclusion

• There is Level 2 evidence that providing enhanced pressure ulcer prevention education is effective at helping individuals with SCI gain and retain this knowledge. 
• There is level 1 evidence that providing enhanced pressure ulcer education and structured follow-up is effective in reducing recurrence of pressure ulcers especially in those individuals with no previous history of pressure ulcer surgery.

• Structured pressure ulcer prevention education, helps individuals post SCI gain and retain knowledge of pressure ulcer prevention practices.
• Research is needed to determine the specific educational needs of individuals with SCI required to reduce the risk of pressure ulcer formation.
• More research is needed to determine if pressure ulcer prevention education results in a reduction of pressure ulcers post SCI.