Identifying and classifying quality-of-life tools for assessing pressure ulcers after spinal cord injury

Abstract

Context

Although pressure ulcers may negatively influence quality of life (QoL) post-spinal cord injury (SCI), our understanding of how to assess their impact is confounded by conceptual and measurement issues. To ensure that descriptions of pressure ulcer impact are appropriately characterized, measures should be selected according to the domains that they evaluate and the population and pathologies for which they are designed.

Objective

To conduct a systematic literature review to identify and classify outcome measures used to assess the impact of pressure ulcers on QoL after SCI.

Methods

Electronic databases (Medline/PubMed, CINAHL, and PsycInfo) were searched for studies published between 1975 and 2011. Identified outcome measures were classified as being either subjective or objective using a QoL model.

Results

Fourteen studies were identified. The majority of tools identified in these studies did not have psychometric evidence supporting their use in the SCI population with the exception of two objective measures, the Short-Form 36 and the Craig Handicap Assessment and Reporting Technique, and two subjective measures, the Life Situation Questionnaire-Revised and the Ferrans and Powers Quality of Life Index SCI-Version.

Conclusion

Many QoL outcome tools showed promise in being sensitive to the presence of pressure ulcers, but few of them have been validated for use with SCI. Prospective studies should employ more rigorous methods for collecting data on pressure ulcer severity and location to improve the quality of findings with regard to their impact on QoL. The Cardiff Wound Impact Schedule is a potential tool for assessing impact of pressure ulcers-post SCI.

Keywords:

• Spinal cord injuries, Quality of life, Pressure ulcers, Outcome assessment, Cardiff wound impact schedule

Acknowledgment

This project was supported by the Ontario Neurotrauma Foundation and the Réseau provincial de recherche en adaptation-réadaptation (REPAR) (Grant nos 2010-KM-SCI-QOL-825; 2008-ONF-REPAR-601; 2007-ONF-REPAR-518); Salary support to Dr SL Hitzig is provided by the Ontario Neurotrauma Foundation and the Rick Hansen Institute (Grant no. 2010-RHI-MTNI-836); Additional support was provided by the Toronto Rehabilitation Institute, which receives funding under the Provincial Rehabilitation Research Program from the Ministry of Health and Long-Term Care in Ontario. The views expressed do not necessarily reflect those of the Ministry.