Objective: To determine which of three approaches to care produces
the lowest incidence of pressure ulcers, promotes the most effective care of
sores that develop, and leads to the fewest hospitalizations in newly injured
patients with spinal cord injury after discharge.
Methods: Spinal cord injury patients (n = 12) were recruited for a
telehealth intervention after initial injury, and matched cases were recruited
for telephone counseling and standard care groups. Patients were monitored for
6–8 months after discharge.
Results: The video group had the greatest number of reported and
identified pressure ulcers. Differences in health care utilization between the
video and telephone telehealth groups were small. The standard care group
reported the lowest number of pressure ulcers and lowest frequency of health
care utilization. Substantial differences existed in employment rates before
and after injury. The video group had the lowest pre-injury rate of employment
and the highest post-injury rate of employment.
Conclusions: Tracking pressure ulcer incidence, particularly stage
I sores, is difficult. Self-report is likely to lead to substantial
underreporting. Similarly, self-report on health care utilization over
extended periods may lead to undercounting of encounters. Telehealth
interventions appear to improve ulcer tracking and management of all ulcer
occurrences. Video interventions may affect outcomes, such as employment
rates, which are not conventionally measured.