Pressure ulcer summit 2018: An interdisciplinary approach to improve our understanding of the risk of pressure-induced tissue damage.

Pressure ulcers (PrUs) affect approximately 2.5 million patients and account for 60,000 deaths annually. They are associated with an additional annual cost of $43,000 per related hospital stay and a total cost to the US health care system as high as $25 billion. Despite the implementation of national and international PrU prevention guidelines and toolkits, rates of facility-acquired PrU s and PrUs in people with spinal cord injury are still high. A new paradigm is needed that distinguishes between prevention and treatment research methods and includes not only the causative factors of pressure and tissue deformation but also patient-specific anatomical differences and the concomitant biological cellular processes, including reperfusion injury, toxic metabolites, ischemia, cell distortion, impaired lymphatic drainage, and impaired interstitial fluid flow that compound existing tissue damage. The purpose of this article is to summarize the highlights from the first annual Pressure Ulcer Summit held February 9-10, 2018 in Atlanta, Georgia (sponsored by the Association for the Advancement of Wound Care in partnership with multiple professional organizations). This international, interdisciplinary summit brought together key stakeholders in wound care and PrU prevention and management to highlight advances in pathophysiology of pressure-induced tissue damage; explore challenges in current terminologies, documentation, and data collection; describe innovations in clinical care; and identify research opportunities to advance the science of PrU prevention and management.

Optimal contraction intensity during proprioceptive neuromuscular facilitation for maximal increase of range of motion.

An informal review of literature on the use of postisometric relaxation (PIR) type proprioceptive neuromuscular facilitation (PNF) indicates that the force of contraction requested from the athlete ranges from 10 to 100% of maximum voluntary isometric contraction (MVIC). The purpose of this study was therefore to determine if an optimal contraction intensity to elicit maximum positive change in range of motion (DeltaROM) exists. This research question was tested across a convenience sample of 56 (37 male and 19 female) university athletes. Target contractions during PNF interventions were set at 20, 50, and 100% MVIC. Pre- and post-PNF intervention hip flexion range of motion (ROM) was measured on a unilateral straight leg raise. The target MVIC of 20, 50, and 100% elicited mean pre-post intervention DeltaROM of 8.4, 12.9, and 11.6 degrees , respectively (all p < or = 0.0001). Differences in pre-post intervention DeltaROM between target contraction intensities were also significant (p = 0.016 to < or = 0.0001). A peak DeltaROM of 13.3 degrees was found at a PNF contraction intensity of 64.3% MVIC. Where optimizing increased ROM in healthy athletes is the desired outcome of PIR-PNF application, coaches and trainers should elicit contraction intensities of approximately 65% MVIC.

The Use of Pressure Mapping: An Educational Report.

A pressure ulcer/injury (PU/I) is caused by multiple factors with sustained pressure being the major contributor to its development. This pressure may be measured by a health care provider using a pressure mapping device in order to assess pressure distribution properties of surfaces used. This educational article describes a general overview, the value, how to perform, and how to incorporate pressure mapping into clinical practice. Also included is an exemplar of a nurse and a physical therapist using pressure mapping to identify the best surface and position for a wheelchair-bound patient in order to minimize PU/I risk.

Content validation of terms and definitions in a wound glossary.

OBJECTIVE: A common language and lexicon provide the easiest means of mutual understanding. Inconsistency in terminology makes effective information exchange difficult. Previous studies identified the need to determine standard, accepted definitions for the vocabulary frequently used in wound care. The objective of this study was to establish content validation for these terms and develop an evidence-based glossary for this specialty. METHODS: Members of the Association for the Advancement of Wound Care Quality of Care Task Force reviewed literature to determine glossary content generation and the associated literature-based definitions. Thirty-nine wound care professionals from wound care stakeholder professional organizations in the United States and Canada participated in the content validation process. Participants were asked to quantify the degree of validity using a 367-item, 4-point Likert-type scale. RESULTS: On a scale of 1 to 4, the mean score of the entire instrument was 3.84. The instrument's overall scale content validity index was 0.96. Terms with an item content validity index of less than 0.70 were removed from the glossary, leaving 365 items with established content validity. Qualitative data analysis revealed themes suggesting that enhanced communication between providers improves patient outcomes. The need for ongoing updates of the glossary was also identified. CONCLUSION: The wound care glossary in its finalized form proved valid. An evidence-based glossary bridges the chasm of miscommunication and nonstandardization so that wound care, as an emerging specialized medical science field, can move forward to optimize both process and clinical outcomes.

Athlete compliance to therapist requested contraction intensity during proprioceptive neuromuscular facilitation.

Contraction intensities between 10 and 100% maximal voluntary contraction (MVC) have been proposed in varying muscle energy technique (MET) and proprioceptive neuromuscular facilitation (PNF) post-isometric relaxation (PIR) protocols. The current study was undertaken to determine if athletes were able to comply with differing therapist requested contraction intensities during (PNF) stretching protocols. Thirty-six university athletes were recruited and MVC was established at hip extension, hip adduction, and horizontal shoulder adduction. Target PIR contractions were set at 20, 50 and 100% MVC and monitored throughout the contractions with a strain gauge dynamometer. Athletes were not able to match the target contraction values at 20 and 100% MVC (P< or =0.001). When examined for consistency across the three component contractions within each of the three PIR protocols, the athletes demonstrated widely variable scores (coefficient of variation (CV)=23.2-36.4% at 20% MVC; CV=19.3-29.4% at 50% MVC; and, CV=9.4-14.5% at 100% MVC). Our findings indicate that this group of athletes displayed a poor level of compliance to varying therapist requested contraction intensities with respect to both accuracy and consistency.