Self-management interventions for skin care in people with a spinal cord injury: part 1\u2014a systematic review of intervention content and effectiveness

Justine S Baron,Arlene Aspinall,Barry White,Katrina J Sullivan,Jeremy M Grimshaw,Dalton Wolfe,Justin Presseau,Jillian M Swaine,Susan Jaglal

doi:10.1038/s41393-018-0138-3

Abstract

Study designSystematic review.ObjectivesTo review the content and effectiveness of skin care self-management interventions for people with SCI.SettingInternational.MethodsWe searched electronic bibliographic databases, trial registers, and relevant reference lists. Eligibility criteria for the reviews of intervention content and effectiveness were identical with the exception of study design. The review of intervention content included non-randomized and randomized controlled trials (RCTs). The review of effectiveness included RCTs. A Behavior Change Technique (BCT) taxonomy of 93 BCTs was used to code intervention content. Intervention effects on outcomes of interest are summarized descriptively. Effect sizes were calculated, and the Cochrane risk of bias tool applied.ResultsIn all, 15 studies testing 17 interventions were included in the review of intervention content. Interventions in these studies included 28 BCTs. The most common were “instructions on how to perform behavior” (16 interventions), “credible source” (12 interventions), and “social support (unspecified)” (9 interventions). Ten RCTs were included in the review of intervention effectiveness and they measured knowledge, self-efficacy, and skills relating to skin care/pressure ulcer (PU) prevention, skin care behaviors, skin status (PU prevalence, severity, and time to PU), and health-care utilization for skin problems. Evidence to support intervention effects on these outcomes was limited, particularly for clinical outcomes. Risk of bias assessments was often inconclusive due to poor reporting.ConclusionsThere is potential to design SCI skin care interventions that include currently untested BCTs. Further research and better consistency in outcome measurements and reporting are required to synthesize evidence on effectiveness.

Highlights

Pressure ulcers (PUs; or pressure injuries) are among the commonest secondary complications affecting people with a spinal cord injury (SCI) living in the community
One way to help prevent PUs in the SCI community is by influencing modifiable risk factors, such as patients’ selfcare behaviors
Some skin care behaviors are commonly performed by people with SCI

Summary

Introduction

Pressure ulcers (PUs; or pressure injuries) are among the commonest secondary complications affecting people with a spinal cord injury (SCI) living in the community. PUs lead to high rates of health-care utilization following discharge from SCI rehabilitation, and one PU adds an average of $18,758 to hospital admission costs in Canada [2]. They result in significant social (e.g., isolation) and financial (e.g., unemployment) limitations, as well as psychological difficulties (e.g., negative emotions) [3]. Some skin care behaviors are commonly performed by people with SCI (e.g., skin care in case of incontinence and examination of the cause of PUs). Others such as daily skin checks and pressure relief are performed by 50% or fewer [5]. Less than 5% of people with SCI adhere to dietary recommendations [6], 37% are inactive [6], and 30% delay visiting a physician after detecting a PU [7]

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