Numerous studies cited in this document have spoken to the fact that pressure ulcers, though largely preventable, are still a common, potentially serious lifelong secondary complication of SCI. Pressure ulcers have the potential to impact overall quality of life (Consortium for Spinal Cord Medicine 2000), disrupt rehabilitation, vocational and educational pursuits and community reintegration (Fuhrer et al. 1993; Krause 1998; Consortium for Spinal Cord Medicine 2000; Jones et al. 200), and lead to increased hospital readmission rates with longer lengths of stay (Chen 2005). Pressure ulcer prevention is more cost effective than treatment (Bogie et al. 2000; Jones et al. 2003). Despite the attention given to prevention strategies, pressure ulcers still occur.

Pressure ulcers are potentially preventable but without evidence to guide practice and education, pressure ulcers will continue to occur. Given the human and economic costs of pressure ulcer formation post SCI, more quality research needs to be done on all aspects of pressure ulcer prevention so that solid evidence is available to individuals with SCI, their families and health care providers.

There are several treatment interventions for pressure ulcers which are supported by level 1 evidence. These include: use of electrical stimulation, US/UVC and pulsed electromagnetic energy as adjunctive therapies and hydrocolloid dressings to assist with the complete healing of stage I and II pressure ulcers post SCI. Well reasoned treatment interventions supported by evidence should be incorporated into treatment plans for individuals with SCI who have pressure ulcers. Providing enhanced pressure ulcer education and structured follow-up has been shown to reduce recurrence of pressure ulcers post SCI.  

• There is limited level 4 evidence that electrical stimulation decreases ischial pressures post SCI.
• There is level 4 evidence that electrical stimulation may increase blood flow at sacral and gluteal areas post SCI.
• There is level 3 evidence that 1-2 minutes of pressure relief must be sustained to raise tissue oxygen to unloaded levels.
• There is level 4 evidence to support position changes to reduce pressure at the ischial tuberosities.
• There is level 3 evidence that various cushions or seating systems (e.g. dynamic versus static) are associated with potentially beneficial reduction in seating interface pressure or pressure ulcer risk factors like skin temperature.
• There is level 3 evidence that adding lumbar support to the wheelchair of those with chronic SCI has a negligible effect on reducing seated buttock pressures at the ischial tuberosities. 
• There is Level 2 evidence showing that early attendance at specialized seating assessment clinics (SSA) increases the skin management abilities of individuals post SCI. 
• 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.
• There is very limited level 4 evidence to suggest that the introduction of behavioural contingencies is associated with a reduction in pressure ulcer severity and decreased health care costs.
• There is level 4 evidence that telerehabiliation does not make a significant difference in the prevention and treatment of pressure ulcers post SCI.  More research is needed into its effectiveness for improving healing and reducing costs.
• There is level 1 evidence from 2 RCTs to support the use of electrical stimulation to accelerate the healing rate of stage III and IV pressure ulcers when combined with standard wound management.
• There is level 1 evidence (from two RCTs) to suggest that laser treatment has no added benefit in pressure ulcer healing post SCI than standard wound care alone.
• There is level 1 evidence, from 1 small RCT, to suggest that combining US/UVC with standard wound care decreases wound healing time of pressure ulcers post SCI but no evidence to clarify whether UVC or US, used alone, have a beneficial effect.
• There is level 1 evidence from one RCT to support the efficacy of pulsed electromagnetic energy to accelerate healing of stage II and III pressure ulcers post SCI.
• There is very limited level 4 evidence that topical negative pressure (TNP) improves healing of pressure ulcers post SCI.
• There is very limited level 3 evidence that the use of a normothermic dressing may improve healing of pressure ulcers post SCI.
• There is Level 2 evidence from one very small study to support the use of maggot therapy as an adjunctive therapy for non-healing stage III and IV pressure ulcers post SCI.
• There is very limited level 4 evidence suggesting the use recombinant human erythropoietin aids in the healing of chronic non healing pressure ulcers in post SCI.
• There is very limited level 4 evidence to support the use of anabolic steroid agents (oxandrolone) to promote healing of stage III and IV pressure ulcers post SCI.
• There is Level 1 evidence from a single RCT that completion of healing for stage I and II pressure ulcers is greater with an occlusive hydrocolloid dressing compared to phenytoin cream or simple dressing post SCI.
• There is Level 2 evidence from a single, small RCT that occlusive hydrogel-type dressings heal more pressure ulcers than conservative treatment post SCI.
• There is level 1 evidence that topical phenytoin shows a trend towards healing of stage I and II pressure ulcers post SCI.
• There is very limited level 4 evidence that topical oxygen therapy may improve healing of pressure ulcers post SCI.