Qualitative study of principles pertaining to lifestyle and pressure ulcer risk in adults with spinal cord injury.

PURPOSE: The aim of this article is to identify overarching principles that explain how daily lifestyle considerations affect pressure ulcer development as perceived by adults with spinal cord injury (SCI). METHOD: Qualitative in-depth interviews over an 18-month period with 20 adults with spinal injury and a history of pressure ulcers were conducted using narrative and thematic analyses. RESULTS: Eight complexly interrelated daily lifestyle principles that explain pressure ulcer development were identified: perpetual danger; change/disruption of routine; decay of prevention behaviors; lifestyle risk ratio; individualization; simultaneous presence of prevention awareness and motivation; lifestyle trade-off; and access to needed care, services and supports. CONCLUSIONS: Principles pertaining to the relationship between in-context lifestyle and pressure ulcer risk underscore previous quantitative findings, but also lead to new understandings of how risk unfolds in everyday life situations. Pressure ulcer prevention for community-dwelling adults with SCI can potentially be enhanced by incorporating principles, such as the decay of prevention behaviors or lifestyle trade-off, that highlight special patterns indicative of elevated risk. The identified principles can be used to theoretically drive future research or to guide innovative lifestyle-focused intervention approaches. Public policies that promote short-term preventive interventions at critical junctures throughout a person's life should be considered.

Mobile arm supports: evidence-based benefits and criteria for use.

BACKGROUND/OBJECTIVE: To collect data from therapists regarding criteria for use and activities that individuals with C4-C5 tetraplegia can perform using a mobile arm support (MAS) that they otherwise could not. Reasons for nonuse, equipment design limitations, and therapist training needs were also studied. METHODS: A modified Delphi approach was used to conduct an e-mail survey for which the response to each question was analyzed and used to formulate the subsequent question. SETTING: Rehabilitation centers. PARTICIPANTS: Eighteen occupational therapists (most affiliated with 1 of the federally designated Model Spinal Cord Injury Systems) with extensive experience in the treatment of individuals with spinal cord injury (SCI). RESULTS: The key physical prerequisite for successful use of the MAS was at least minimal strength of the deltoid and biceps muscles; 92% of respondents indicated that they would fit an MAS for motivated patients having very weak (<2/5) biceps and deltoid muscles. According to the therapists, 100% (n = 30) of their clients were able to perform at least 1 activity using a MAS that they were unable to perform without the device. These activities included (in descending frequency) eating, page turning, driving a power wheelchair, brushing teeth, keyboarding, writing, name signing, drawing, painting, scratching nose, playing board games, accessing electronic devices, drinking, and grooming. Equipment design limitations included increased wheelchair width and problems managing the arms while reclining. CONCLUSIONS: Mobile arm supports allow persons with C4-C5 tetraplegia to engage in activities that they otherwise cannot perform with their arms.

Data-based models of how pressure ulcers develop in daily-living contexts of adults with spinal cord injury.

OBJECTIVE: To examine the daily-lifestyle influences on the development of pressure ulcers in adults with spinal cord injury (SCI). DESIGN: Qualitative investigation using in-depth interviewing and participant observation. SETTING: Participants were studied in their homes and other naturalistic contexts. PARTICIPANTS: Twenty men and women of diverse ethnicities with paraplegia or tetraplegia who were recruited at a pressure ulcer management clinic in a large rehabilitation facility. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Detailed descriptive information pertaining to the development of recurring pressure ulcers in relation to participants' daily routine and activity, personal choices, motivating influences, lifestyle challenges, and prevention techniques and strategies. RESULTS: The daily-lifestyle influences on pressure ulcer development in adults with SCI can be described through various models that vary in complexity, depending on whether they incorporate individualization, interrelations among modeled elements, situational specificity, and/or temporal comprehensiveness. Ulcers are most likely to develop when a person with a relatively high-risk background profile is exposed to an equilibrium-disrupting change event that culminates in a specific pressure ulcer risk episode. CONCLUSIONS: The results underscore the significant degree of complexity and individualization that characterize the emergence of pressure ulcers in daily-life contexts. Prevention efforts should therefore incorporate attention to the unique constellation of circumstances that comprise a person's everyday life.