LIFESTYLE REDESIGN FOR PRESSURE ULCER PREVENTION IN SCI

描述(由申请人提供)：晚期压疮是脊髓损伤(SCI)的常见和严重的医学并发症，与极高的治疗费用和降低的生活质量有关。然而，解决这一问题的预防性干预措施很少受到研究关注。为了解决这一差距，我们将调查一种有前景的生活方式干预的有效性，该干预旨在预防脊髓损伤人群高危成员中的压疮。这项为期五年的研究将涉及南加州大学(USC)和兰乔洛斯阿米戈斯国家康复中心(RLANRC)的研究人员之间的合作，他们根据对成年脊髓损伤患者的生活方式和溃疡风险的定性调查结果开发了干预措施。该项目的长期目标是确定一种干预方案，以提高成年脊髓损伤患者的健康和生活质量，同时减轻脊髓损伤相关压疮问题造成的沉重医疗负担。拟议研究的具体目标是：(A)进行一项随机临床试验，以确定干预措施能否降低成人脊髓损伤患者的重度(3级或4级)压疮的发生率；(B)评估干预措施的成本效益和潜在的成本节约；(C)检查干预措施对参与者生活质量的影响；以及(D)模拟调节干预效果的过程机制。为了实现这些目标，将在一家大型康复机构招募160名不同种族的男性和女性(包括说英语和西班牙语的人)，他们在SCI后至少6个月并有至少一次严重压疮的病史，并随机分配到基于生活方式的干预条件或标准护理控制条件中。干预措施将包括家访和电话，目的是为每个客户制定个性化的压疮预防计划。研究参与者将在试验的干预阶段完成后接受为期一年的跟踪。结果分析将测试干预是否减少了新的严重溃疡的发生率，减少了手术和其他与溃疡相关的医疗费用，和/或提高了生活质量。该项目将通过增加由于压疮问题而处于疾病和住院高风险的一大部分个人的身体和心理健康，从而使公共健康受益。如果成功，这种干预将有能力产生大量的财务节省，从而帮助抵消社会不断上涨的医疗成本。公共卫生相关性：医学上严重的压疮是脊髓损伤的常见并发症，与极高的治疗费用和降低的生活质量有关。在这项研究中，我们将测试一种生活方式干预，它有望显着减少成人脊髓损伤人群中的压疮。

DESCRIPTION (provided by applicant): Advanced pressure ulcers are a common and medically serious complication of spinal cord injury (SCI) and are associated with extremely high treatment costs and reduced quality of life. However, preventive interventions that address this problem have received very little research attention. To address this gap, we will investigate the efficacy of a promising lifestyle intervention designed to prevent pressure ulcers among at-risk members of the SCI population. The resulting five-year study will involve collaboration between researchers from the University of Southern California (USC) and Rancho Los Amigos National Rehabilitation Center (RLANRC), who have developed the intervention based on the results of a qualitative investigation of lifestyle and ulcer risk among adults with SCI. The long-term objective of this project is to identify an intervention option that can enhance the health and life quality of the population of adults with SCI while simultaneously diminishing the heavy healthcare burden that results from the problem of SCI-related pressure ulcers. The specific aims of the proposed research are to: (a) conduct a randomized clinical trial of the intervention's ability to reduce the incidence of high grade (Stage 3 or 4) pressure ulcers in adults with SCI; (b) assess the cost-effectiveness and potential cost savings of the intervention; (c) examine the intervention's effects on participants' quality of life; and (d) model the process mechanisms that mediate the effects of the intervention. To accomplish these aims, 160 ethnically diverse men and women (including English and Spanish speakers) who are at least 6 months post-SCI and who have a history of at least one previous severe pressure ulcer will be recruited at a major rehabilitation facility and randomly assigned to either a 12- month lifestyle-based intervention condition or a standard care control condition. The intervention will consist of in-home visits and phone calls, with the intent to develop for each client a personalized plan for pressure ulcer prevention. Study participants will be followed for one year following the completion of the intervention phase of the trial. Outcome analyses will test whether the intervention reduces the incidence of new serious ulcers, reduces surgeries and other ulcer-linked medical treatment costs, and/or enhances quality of life. The project will benefit public health by increasing the physical and emotional wellness of a large sector of individuals who are at high risk for sickness and hospitalization due to the pressure ulcer problem. If successful, the intervention has the capacity to generate large financial savings and thereby help counteract society's rising healthcare costs. PUBLIC HEALTH RELEVANCE: Medically serious pressure ulcers are a common complication of spinal cord injury and are associated with extremely high treatment costs and reduced quality of life. In this study we will test a lifestyle intervention that promises to significantly reduce pressure ulcers in the population of adults with spinal cord injury.