Text messages for pressure ulcer prevention in spinal cord injury
Research type
Research Study
Full title
Educational Text Messaging for pressure ulcer prevention in people with spinal cord injury who are newly discharged from hospital - A pilot study
IRAS ID
219199
Contact name
Liang Qin Liu
Contact email
Sponsor organisation
Middlesex University
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Summary of Research
Up to 85% of people with spinal cord injury (SCI) have a pressure Ulcer (PrU) at some point during their lifetime. A third to half of PrU incidence results from sitting in a wheelchair. Once a PrU is formed, it is extremely difficult to fully repair. Management of PrU is extremely expensive,accounting for approximately 25% of overall treatment costs for people with SCI. In the UK, treating one episode of PrU costs £1,214 to £14,108. Therefore, PrU prevention is vitally important in the SCI population.
To date, enormous efforts have been made to prevent PrU. For example, patients are provided expensive cushions and asked to perform ‘pressure-relief’ regularly. Yet the incidence of PrU remains unacceptably high in the SCI populations.We recently completed a study to gain people’s view about PrU prevention in the SCI population. The majority of patients reported that lack of knowledge of skin care after the discharge alongside ignorance or loss of motivation performing ‘pressure-relief exercise.
Interestingly, previous studies in the literature indicated that text messaging as a reminder can improve adherence to medication and exercise regimen. Therefore, the current project is designed to look at whether the text message as a reminder would improve patients’ concordance with the ‘pressure relief’ regimen, and quality of life as well as reduce the PrU incidence in people with SCI.
We will recruit a total of 24 participants who are discharged from Royal National Orthopaedic hospital following a new diagnosis of SCI. Half of them will receive a text message twice a week for six months. All participants will receive standard follow-up rehabilitation care. We will assess participants’ concordance with pressure-relief regimen, quality of life and incidence of all grades of PrU at baseline, month three and six.
Summary of Results
Thirty-eight people with spinal cord injuries participated in this study. Twenty people received the interventions by getting text messages twice per week to remind them skin care for 6 months. While 18 people received standard care without text messaging reminders after they left the hospital. One person who received standard care didn't answer enough questions in the 1st questionnaire before he/she left the hospital, and was therefore excluded in our results.
We looked at how much people knew about skin care and how well they followed the advice they were given before leaving hospital and 3 to 6 months later. We also looked at any pressure ulcer incidence during the 3 to 6 months after they leaving hospital.
Of those 37 people who completed the questionnaires, twenty-seven people were men and 10 were women with an average age of 51.8 years. Fourteen of these 37 people answered a follow-up questionnaire 3 to 6 months later. Of the 14 people who answered the follow-up questionnaire, 8 received text messages, 6 received standard care without text messaging.
We analysed the answers of the 37 people who completed the questionnaires. We found that people who thought pressure ulcers were more serious were more likely to take action to prevent them.
Participants who got text message reminders reported performing more pressure-relieving exercises and adhering better to skincare routines than those who did not receive messages. They also said that they felt more confident in preventing pressure ulcers than those who didn't get text messages. They also viewed pressure ulcers as a more serious problem.
Overall, text messaging seemed to be an effective reminder/intervention to improve adherence to preventive measures for pressure ulcers.
For those people who received intervention, we also asked them about their satisfaction with the messages. Four participants who received text messages responded to our satisfaction questions. All of them agreed that the messages were easy to understand and included all the necessary information. They also reported increased confidence in preventing pressure ulcers and found the content of the messages helpful.
Regarding the impact of text messaging on the pressure ulcer occurrence, a quarter of (2 out 8) people who received text messaging reported having a pressure ulcer within 6 months. A third of (2 out 6) people who didn’t receive text messaging reported having a pressure ulcer within 6 months Although fewer proportion of people in the intervention group had pressure ulcers during the study than in the control group, this difference was not statistically significant, possibly because the study had a small sample size.
In summary, we tested a method sending text messages to remind people with spinal cord injuries (SCI) to prevent pressure ulcers after leaving the hospital. We asked them questions to understand how they felt about pressure, their experiences, knowledge, and skincare practices. The participants receiving text messaging liked the text messages and were more likely to do pressure relief exercises and take care of their skin. However, because relatively small number of people in each group, we cannot be sure if the text messaging actually prevented pressure ulcer when compare those people who didn’t receive text messages. Therefore, more larger sample rigorous studies are needed to see if text messaging can prevent pressure ulcer in the long-term.REC name
South West - Central Bristol Research Ethics Committee
REC reference
17/SW/0097
Date of REC Opinion
27 Apr 2017
REC opinion
Further Information Favourable Opinion