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Arora M.1, Harvey L.A.1, Hayes A.2, Chhabra H.3, Glinsky J.1, Lavrencic L.4, Arumugam N.5, Hossain S.6, Bedi P.5, Cameron I.1
1The University of Sydney, Sydney Medical School, Sydney, Australia, 2The University of Sydney, School of Public Health, Sydney, Australia, 3Indian Spinal Injuries Centre, Spine Services, New Delhi, India, 4Royal North Shore Hospital, Spinal Unit, Sydney, Australia, 5Punjabi University, Physiotherapy Department, Patiala, Punjab, India, 6Centre for Rehabilitation of the Paralysed, Physiotherapy Department, Savar, Bangladesh
Background: Pressure ulcers (PUs) following spinal cord injury (SCI) are common with serious consequences. Treatment of PUs in high-income countries is intensive and multi-faceted. However such resource-intensive treatments are not feasible in low- and middle-income countries (LMICs), where people with SCI are largely left to manage their PUs alone and at home. In LMICs, physiotherapists play a large role in advising and helping people to manage their PUs. Regular advice from a physiotherapist over the telephone might be a realistic and low cost option.
Purpose: The aim of this study was to determine whether a low-cost model of care involving weekly telephone contact with patients was effective for helping them manage their PUs.
Methods: A 12-week multicenter, prospective, assessor-blinded, parallel randomised controlled trial was conducted in India and Bangladesh. Participants were included if they sustained a SCI more than 3 months prior and had at least one PU. Participants were randomly allocated to usual care or to usual care with weekly telephone contact. The weekly telephone contact was with a trained physiotherapist. The physiotherapist provided ongoing advice and support. Specifically, this included reinforcing self-help strategies for managing their PUs, minimising psychological stress and enhancing engagement with life. The primary outcome was the size of the PU at 12 weeks. There were 13 secondary outcomes including the Pressure Ulcer Scale of Healing, PU depth, the Braden Scale and satisfaction with healthcare service delivery.
Results: One hundred and twenty participants were randomised. The mean between-group difference for size of PU at 12 weeks was 1.1 cm2 (95% CI, -0.8 to 4.3) falling to rule in or out a treatment effect. However, the survival analysis reflecting time to healing and seven of the thirteen secondary outcomes were statistically significant.
Conclusion(s): Regular advice from a physiotherapist over the telephone did not reduce PU size but the results of most of the secondary outcomes indicated a positive effect.
Implications: While the primary outcome was inconclusive, there is sufficient promise in the secondary outcomes to justify a larger definitive trial. This is particularly important because we may yet prove that regular advice from a physiotherapist over the telephone provides an inexpensive way to help relieve the insidious problem of PUs in LMICs.
Funding acknowledgements: There was no funding for this study.
Topic: Neurology: spinal cord injury
Ethics approval: The trial was approved by the Institutional Ethics Committees at each site.
All authors, affiliations and abstracts have been published as submitted.
