Comparing Multicomponent Interventions to Improve Skin Care Behaviors and Prevent Recurrence in Veterans Hospitalized for Severe Pressure Ulcers
Comparing Multicomponent Interventions to Improve Skin Care Behaviors and Prevent Recurrence in Veterans Hospitalized for Severe Pressure Ulcers
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DOI：
10.1016/j.apmr.2014.01.012
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发表时间：
2014-07-01
影响因子：
4.3
通讯作者：
Holmes, Sally A.
中科院分区：
文献类型：
--
作者：
Guihan, Marylou;Bombardier, Charles H.;Holmes, Sally A.
目的：比较多成分动机访谈(MI)/自我管理（SM）干预与多成分教育干预在改善重症压疮（PrUs）脊髓损伤退伍军人皮肤保护行为和预防皮肤恶化方面的作用。设计：单盲、前瞻性、随机对照试验。地点：六个退伍军人事务SCI中心。参与者：因严重（III/IV期）PrU入院的退伍军人随访至出院后6个月。干预：以电话为基础的个人MI咨询+ SM技能组（SM+MI; n=71）与以电话为基础的个人教育咨询+团体教育的积极对照组（n=72）。主要观察指标：自我报告皮肤保护行为，客观皮肤恶化。结果：意向治疗分析发现，与教育控制干预组相比，SM+MI组在3个月和6个月时皮肤行为无显著增加。SM+MI和教育控制干预参与者的行为差异为4.6%(95%置信区间[CI]， -11.3至2.7)（0-3个月）和3.0% (95% CI， 8.7至3.9)（0-6个月）。皮肤恶化率较高（n=74, 51.7%），通常发生在出院后3个月内，最常发生在出院后1个月内。不同研究组的皮肤恶化、皮肤相关就诊和再入院没有差异。提出了研究的局限性。结论：对于慢性脊髓损伤和严重pru合并多种合并症的患者，仅仅关注改善患者行为可能不足以解决脊髓损伤中pru的复杂问题。为了减少PrU的复发，可能需要更多的卫生保健系统水平的改变，如协作护理，特别是在这个许多人未痊愈出院或几乎没有坐耐力的时代。(C) 2014年由美国康复医学大会发布
Objective: To compare a multicomponent motivational interviewing (MI)/self-management (SM) intervention with a multicomponent education intervention to improve skin-protective behaviors and prevent skin worsening in veterans with spinal cord injury (SCI) hospitalized for severe pressure ulcers (PrUs).Design: Single-blinded, prospective, randomized controlled trial.Setting: Six Veterans Affairs SCI centers.Participants: Veterans admitted for a severe (stage III/IV) PrU were followed up to 6 months postdischarge.Intervention: Telephone-based individual MI counseling plus SM skills group (SM+MI; n=71) versus an active control group of telephone-based individual educational counseling plus group education (n=72).Main Outcome Measures: Self-reported skin-protective behaviors, objective skin worsening.Results: Intention-to-treat analyses found nonsignificant increases in skin behaviors in the SM+MI versus education control intervention arms at 3 and 6 months. The difference in behaviors used between SM+MI and education control intervention participants was 4.6% (95% confidence interval [CI], -11.3 to 2.7) (0-3mo) and 3.0% (95% CI, 8.7 to 3.9) (0-6mo). High rates of skin worsening were observed (n=74, 51.7%), usually within 3 months postdischarge and most frequently within the month postdischarge. Skin worsening, skin-related visits, and readmissions did not differ by study arm. Study limitations are presented.Conclusions: For persons with chronic SCI and severe PrUs, complicated by multiple comorbidities, a primary focus on improving patient behavior is likely insufficient to address the complex problem of PrUs in SCI. More health care systems level changes such as collaborative care may be needed to reduce PrU recurrence, especially in this era in which many people are discharged from the hospital unhealed or with little sitting tolerance. (C) 2014 by the American Congress of Rehabilitation Medicine