Use of behavioral contingencies to promote prevention of recurrent pressure ulcers

To determine effectiveness of an intervention using monetary rewards as a consequence for preventing or reducing severity of pressure ulcers in spinal cord injury (SCI) patients with a history of chronic, recurrent ulcers.

Multiple baseline analysis across subjects (time-lagged control), comparing severity of pressure ulcers and treatment costs during baseline and intervention.

Outpatient wound-care clinic of private, nonprofit specialty hospital.

Nine adults (all with paraplegia) with a history of hospitalizations for treatment of pressure ulcers.

In study 1, participants (n=6) undertook (1) a comprehensive self-care plan, (2) had a graduated schedule of visits with an advanced practice nurse, and (3) received monetary rewards for successfully preventing serious ulcers. In study 2, participants (n=3) undertook interventions 1 and 2, but monetary rewards were in staged phases so a component analysis could compare the effectiveness of visits alone to visits plus monetary rewards.

Severity of pressure ulcers measured with the Pressure Ulcer Scale for Healing (PUSH Tool 3.0); and direct costs of treatment and preventive care for pressure ulcers.

In study 1, severity of pressure ulcers-and their related treatment costs-decreased for the 6 participants. Maintenance of effects postintervention was highly variable, with only 3 participants showing long-term improvements. In study 2, for 2 participants, visits alone did not reduce pressure ulcer severity, but visits plus payments did effectively reduce ulcer severity, indicating improved prevention behaviors.

Findings support the assumption that pressure ulcers may recur among some individuals because there are insufficient positive consequences for effective prevention.