Preventing recurrent pressure ulcers in veterans with spinal cord injury: Impact of a structured education and follow-up intervention

Objective: To test the hypothesis that enhanced education and structured follow-up after pressure ulcer surgery will result in fewer recurrences. Design: Randomized controlled trial. Setting: Veterans Affairs medical center. Participants: Forty-nine veteran men with spinal cord injury or dysfunction were approached on admission for pressure ulcer surgery. Five never had surgery, 2 refused to participate, and one withdrew. Forty-one were randomized into 3 groups. Three participants' ulcers did not heal, so follow-up could not begin. Interventions: Group 1 received individualized pressure ulcer education and monthly structured telephone follow-up (n=20); group 2 received monthly mail or telephone follow-up without educational content (n=11); and group 3 received quarterly mail or telephone follow-up without educational content (n=10). Follow-up continued until recurrence, death, or 24 months. Main Outcome Measure: Time to pressure ulcer recurrence. Results: Group 1 had a longer average time to ulcer recurrence or end of study than groups 2 and 3 (19.6mo, 10.1mo, 10.3mo; P=.002) and had a smaller rate of recurrence (33%, 60%, 90%; P=.007). Survival analysis confirmed these findings (P=.009). Conclusions: Individualized education and structured monthly contacts may be effective in reducing the frequency of or delaying pressure ulcer recurrence after surgical repair of an ulcer.