LIFESTYLE REDESIGN FOR PRESSURE ULCER PREVENTION IN SCI

重新设计生活方式以预防 SCI 压疮

• 批准号: 8106104
• 负责人: FLORENCE A. CLARK
• 金额: $ 50.79万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8106104
• 关键词: Address; Adult; Attention; Behavior; California; Client; Collaborations; Communities; Complication; Cost Savings; Decubitus ulcer; Emotional; Health; Health Care Costs; Healthcare; Home visitation; Hospitalization; House Call; Incidence; Individual; Intervention; Investigation; Knowledge; Life Style; Link; Manuals; Measures; Mediating; Medical; Modeling; Operative Surgical Procedures; Outcome; Participant; Performance; Persons; Phase; Population; Prevention; Preventive; Preventive Intervention; Process; Public Health; Quality of life; Randomized; Randomized Clinical Trials; Recording of previous events; Recruitment Activity; Rehabilitation Centers; Rehabilitation therapy; Relative (related person); Research; Research Personnel; Risk; Sampling; Savings; Self Efficacy; Series; Social support; Societies; Spinal cord injury; Staging; Telephone; Testing; Treatment Cost; Ulcer; Universities; Woman; base; behavior change; cost effective; cost effectiveness; efficacy trial; follow-up; high risk; improved; intervention effect; lifestyle intervention; member; men; prevent; standard care; successful intervention; therapy design

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.

描述（由申请人提供）：晚期压疮是脊髓损伤（SCI）的一种常见且医学上严重的并发症，与极高的治疗费用和生活质量下降有关。然而，解决这一问题的预防性干预措施却很少受到研究关注。为了弥补这一差距，我们将研究一种有前途的生活方式干预措施的功效，该干预措施旨在预防 SCI 人群中的高危人群发生压疮。由此产生的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，他们根据对生活方式和溃疡风险的定性调查结果制定了干预措施患有 SCI 的成人。该项目的长期目标是确定一种干预方案，可以提高 SCI 成人人群的健康和生活质量，同时减轻 SCI 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) 开展一项随机临床试验，探讨干预措施是否能够降低成人 SCI 中重度（3 期或 4 期）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； (d) 对调节干预效果的过程机制进行建模。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 个月且之前至少有过一次严重压疮病史。分配至 12 个月基于生活方式的干预条件或标准护理控制条件。干预措施将包括上门拜访和电话，旨在为每位客户制定个性化的压疮预防计划。试验干预阶段完成后，研究参与者将被跟踪一年。结果分析将测试干预措施是否降低新发严重溃疡的发生率、减少手术和其他与溃疡相关的医疗费用和/或提高生活质量。该项目将通过改善大量因压疮问题而患病和住院的高风险人群的身心健康，从而造福公共健康。如果成功，干预措施将能够节省大量资金，从而有助于抵消社会不断上涨的医疗费用。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生活质量下降有关。在这项研究中，我们将测试一种生活方式干预措施，该干预措施有望显着减少脊髓损伤成年人群中的压疮。