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A Brief Review of New Research to Prevent and Manage Bedsores Among Patients Living With Spinal Cord Injury

Spinal cord injury (SCI) is an irreversible, debilitating condition associated with devastating long-term health problems, including impaired mobility, loss of sensation, chronic pain, and psychological distress. People who experience partial or total paralysis after SCI are also at high risk of developing pressure ulcers (also called bedsores), localized damage to skin and tissue caused by prolonged pressure and friction.

People with SCI who are bedbound or use wheelchairs as a result of their injury tend to remain in a prone or seated position for long periods of time, resulting in ulcer wounds on areas where soft tissue rubs over bone (such as the hips and tailbone). A recent study found that one in three SCI patients worldwide suffer from bedsores at any given time,1 and other studies have estimated that up to 80% of SCI patients will experience a bedsore at least once in their lifetime.2 Immobile SCI patients with loss of sensation may be at even higher risk of developing bedsores, as they may be unable to feel pain that would prompt them to relieve pressure by shifting their position.

In addition to pain, bedsores are associated with a number of complications that can significantly impair the SCI recovery process and may reduce an individual’s overall quality of life. Superficial bedsores may heal with daily care and cleaning, but deeper wounds often cause serious infections and may require surgical intervention. Surgery for pressure ulcers is typically effective, but an estimated 43% individuals with SCI who receive surgery for their bedsores will experience post-operative complications that can further hinder the healing process and may reduce quality of life in the days or weeks following surgery.2

Given the risks and complications associated with bedsores, clinicians are highly motivated to identify and prevent bedsores before they occur, thereby reducing SCI patients’ risk of pain, infection, surgical complications, and other negative health outcomes. Researchers are aiding this effort by designing innovative tools, treatments, and interventions to help clinicians and SCI patients collaboratively prevent and manage pressure ulcers. Some of these recent research initiatives are highlighted below.

In May this year, a group of experts convened a panel to discuss the development of a mobile health app that would help SCI patients self-manage their bedsores. The experts were concerned about the amount of health-related misinformation available on the internet, therefore they were specifically interested in developing a set of guidelines for selecting high-quality, evidence-based content for their new app. After discussing the challenges related to gathering and quality-controlling the content, the experts decided that all content published on the app should undergo a three-step review procedure. First, experts should identify existing evidence and recommendations on bedsore management; then, they should hold a meeting to evaluate the evidence and obtain consensus on which recommendations are most relevant for the mobile health app; and last, the experts should consolidate their findings before transforming the recommendations into user-friendly mobile app content.3 These efforts represent experts’ commitment to developing high-quality, rigorously reviewed tools to improve health and quality of life among patients with SCI.

Another study in June also contributed to this mission by evaluating a variety of wheelchair cushions to determine the best material for preventing bedsores among people with SCI. They found that wheelchair users who sit on air-inflated cushions experience less direct pressure on soft tissues, reducing their risk of pressure ulcers from prolonged sitting. Gel cushions were somewhat less effective than air cushions but more effective than foam cushions, indicating that clinicians ideally should discourage their high-risk SCI patients from using foam cushions in their wheelchairs.4

Most recently, in July, a group of researchers in Switzerland developed a novel cushion technology to help wheelchair users engage in pressure-relieving activities that would reduce their risk of developing pressure ulcers. The innovative cushions are lined with a special fabric designed to sense pressure. When the cushion sensors detect that a wheelchair user has been seated in one position for too long, the sensors notify a smartphone app that reminds the user to shift their position in the chair, relieving pressure on areas that are prone to bedsores. The researchers found that wheelchair users who used the new feedback technology completed 82% of the clinician-recommended pressure relief shifts, compared to wheelchair users without the technology, who only completed 11% of the recommended pressure relief shifts.5

These important research initiatives demonstrate experts’ ongoing commitment to developing innovative, accessible methods for promoting health, safety, and quality of life among individuals living with SCI. With hope, mobile apps and new technologies will alleviate the pain and burden associated with bedsores among all individuals living with limited mobility.

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