An Observational Study to Evaluate the Risk Factors and Quality of Life in Individuals With Spinal Cord Injury and Pressure Injuries

TL;DR

This study examines risk factors and quality of life in people with spinal cord injuries and pressure injuries in India, finding that complete injuries and factors like moisture are linked to severe pressure injuries.

Contribution

The study provides insights into PI risk factors and QoL in SCI individuals in a developing country context, emphasizing the need for targeted prevention.

Findings

Complete SCI (AIS A) is strongly associated with higher-stage pressure injuries.

Modifiable risk factors like moisture and friction are significantly linked to severe PIs.

Quality of life is impaired across all domains, with social relationships being most affected.

Abstract

Background

Spinal cord injury (SCI) is a debilitating condition often associated with many complications, of which pressure injury (PI) is one of the most prevalent. Individuals with SCI are at an increased risk of developing PIs due to impaired protective sensations, dependence for mobility, and co-morbidities. Individuals with PIs often report an increase in morbidity, healthcare-related expenditure, and reduced quality of life (QoL). However, there is a paucity of data on PI-related risk factors and QoL outcomes in SCI individuals in developing countries like India. This study aimed to assess risk factors contributing to different stages of PI in individuals with SCI and to evaluate the impact of PI on their QoL.

Methodology

This was a cross-sectional observational study conducted over a period of 18 months at the All India Institute of Medical Sciences (AIIMS) Bhopal, India. A total of 134 individuals with SCI and PI were enrolled after considering all the inclusion and exclusion criteria. Data involving demographic profiling, physical examination, and hematological investigations were collected. Risk factors were assessed using the Braden Scale and Spinal Cord Injury Pressure Ulcer Scale (SCIPUS). Staging of PIs was done according to the Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System. Neurological level was classified using the American Spinal Injury Association (ASIA) Impairment Scale (AIS). QoL was determined using the World Health Organization Quality-of-Life Scale brief version (WHOQOL-BREF) questionnaire. Statistical analysis was done to assess the risk factors and their relation with SCI severity, PI stage, and QoL.

Results

The participants' mean age was 38.65 years and 76.87% were men. Labourers were the most often affected (35.82%). Most participants were paraplegic (64.93%), and trauma was the most common cause of SCI etiology (66.42%). Stage 4 PI was observed (35.24%) more often than other stages and was followed by Stage 2 PI (34.46%). Complete SCI (American Spinal Injury Association (ASIA) Impairment Scale (AIS) A) was strongly associated with higher-stage PI. Risk factors such as limited mobility, moisture, and friction/shear were significantly linked to higher PI stages. Bed-bound individuals were more prone to Stage 3, while stage 4 PI was predominant in wheelchair-bound individuals. Braden and SCIPUS scores showed decreasing risk for PI from AIS A to D. WHOQOL-BREF revealed that all domains of QoL were adversely affected, but social relationship was reported as a major concern in our participants. However, no significant association was found between stage of PI and QoL scores.

Conclusion

This study highlights the strong correlation between complete SCI and higher-stage of PIs, with modifiable risk factors like moisture and friction having a substantial impact. PI considerably impairs all QoL domains, particularly social relationships. These findings emphasise the need for targeted preventive strategies and standard protocols to arrest PI progression and improve QoL of individuals with SCI. This is among the first such studies in central India, offering valuable insights for future clinical and rehabilitative planning.

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