No bed rest for pressure sores!??!

[lynnifer]

http://clinicaltrials.gov/ct2/show/N...+canada&rank=1

I was shocked to see this tonight (can't sleep). What they are saying about bedrest is certainly true though, in my experience, as far as detrimental effects on other body systems as well as emotional effects.

Purpose

People with spinal cord injuries posses many factors that increase their risk of developing pressure ulcers. Not surprisingly, approximately 82% of persons with spinal cord injury (SCI) will experience a pressure ulcer at sometime during their life. Earlier guidelines for the assessment and treatment of pressure ulcers produced by RNAO in 2002 recommended that "a client who has a pressure ulcer on a seating surface should avoid sitting." Unfortunately, this recommendation has fueled the long standing view that people with pressure ulcers should stop using their wheelchairs and return to bed. The strength of evidence assigned for this recommendation was Level=C reflecting the paucity of research evidence to support this common practice. Not only do the benefits of bed rest on healing remain to be demonstrated, there is mounting evidence that bed rest can be harmful to a person's overall health and well being. Bed rest has been shown to be strongly associated with complications in most body systems including respiratory, cardiovascular, musculoskeletal, cerebrovascular, gastrointestinal, and genital-urinary. Psychosocial complications and cognitive impacts are also well documented. Without evidence to dispel the myth that "bed rest is best" it will be difficult to change practice and avoid many of the secondary complications.

This study is a pilot study to

1) determine whether pressure ulcers heal faster in individuals with SCI who receive an individualized community-based, pressure management and mobility program compared to a similar group assigned to usual care (bed rest)

2) determine the strength of the association between the intervention (pressure/mobility or bedrest) and wound healing, motor performance/independence and quality of life while adjusting for motivation to regain independence, degree of caregiver burden, and compliance with the intervention

3) determine whether individuals with SCI who participate in a pressure/mobility management program experience fewer secondary complications than those who do not participate

4) determine the cost-effectiveness of providing a time-efficient, pressure management and mobility program compared to bed rest.

[611]

Originally Posted by lynnifer

http://clinicaltrials.gov/ct2/show/N...+canada&rank=1

I was shocked to see this tonight (can't sleep). What they are saying about bedrest is certainly true though, in my experience, as far as detrimental effects on other body systems as well as emotional effects.

Purpose

People with spinal cord injuries posses many factors that increase their risk of developing pressure ulcers. Not surprisingly, approximately 82% of persons with spinal cord injury (SCI) will experience a pressure ulcer at sometime during their life. Earlier guidelines for the assessment and treatment of pressure ulcers produced by RNAO in 2002 recommended that "a client who has a pressure ulcer on a seating surface should avoid sitting." Unfortunately, this recommendation has fueled the long standing view that people with pressure ulcers should stop using their wheelchairs and return to bed. The strength of evidence assigned for this recommendation was Level=C reflecting the paucity of research evidence to support this common practice. Not only do the benefits of bed rest on healing remain to be demonstrated, there is mounting evidence that bed rest can be harmful to a person's overall health and well being. Bed rest has been shown to be strongly associated with complications in most body systems including respiratory, cardiovascular, musculoskeletal, cerebrovascular, gastrointestinal, and genital-urinary. Psychosocial complications and cognitive impacts are also well documented. Without evidence to dispel the myth that "bed rest is best" it will be difficult to change practice and avoid many of the secondary complications.

This study is a pilot study to

1) determine whether pressure ulcers heal faster in individuals with SCI who receive an individualized community-based, pressure management and mobility program compared to a similar group assigned to usual care (bed rest)

2) determine the strength of the association between the intervention (pressure/mobility or bedrest) and wound healing, motor performance/independence and quality of life while adjusting for motivation to regain independence, degree of caregiver burden, and compliance with the intervention

3) determine whether individuals with SCI who participate in a pressure/mobility management program experience fewer secondary complications than those who do not participate

4) determine the cost-effectiveness of providing a time-efficient, pressure management and mobility program compared to bed rest.

I've been saying this for years. With all due respect to KLD,her protocol for recovery is disclaimed by studies done by Plastic Surgeons.New cushions allow people to be up with less pressure than the best low pressure bed. This is a good site but too many experts post personal opinions rather than facts. Accepted protocol after flap surgery is 2 weeks immobilization followed by 2 weeks of limited movement and sitting.Some drs have patients sitting within several days of surgery.
Can you imagine the walking population laying around 2 mos or so after surgery. We cripples are not considered productive thus we can lie around forever.Hell,most HO develops after prolonged periods of immobility.
i've askd the nurses here several times about the SCIs they treat. I bet very few of them are employed. Take subtance abusers out of the VA hospitals in my area and the census would drop 50%. Most are not service connected.Most working Vets go to private hospitals.
Lynn,we need to demand more accountability from our drs rather than let them warehouse us in hospitals.
These drs who immobilize you for six weeks are covering their lazy asses at your expense. They don't have confidence in their work. Lawsuits frighten them and they'd rather be working on your eyelids,tummy,or breasts.
Lynn,watch this flap surgery recovery protocol change in the coming years. My buddy went home 4 days after quadrupal bypass surgery. His skin did not rip open. TForty yrs ago,the experts were saying rest.
The Medical Model of disability is archaic and views people as unemployable and less valuable than their able bodied counterparts.

[betheny]

LOL. SusanM is right again! I used to see those guys at the VA, face-down on those wheeler-gurneys for months. What a shame if that was unnecessary...

[trainman]

The many sores, craters, I've had on my upper legs and butt have all been closed using muscle flaps. Treatment after surgery is always six weeks of bed rest and slowly returning to the chair. However, with my mattress, I can sit up in bed and do work.

Before surgery, my sores don't always care, but often do better in my chair than in bed. So I agree that the chair is usually better, but not sure that that's always the case.

[titanium4motion]

I see truth in this study.

I myself have not had a pressure sore post 21 years. I check myself twice everyday, after my shower and before I go to sleep. I also eat right everyday. All my life I have eaten plain yogurt everyday too. It makes me wonder if that yogurt has properties that help strengthen the skin from getting pressure sores?

Reading posts here about pressure sores many people do get up in their 'chairs to do something or other. Lying in bed for any length of time, one week, two weeks or six weeks has detrimental effects on the mind and body. I agree that there can be a balance between healing a pressure sore, bed rest, psychological and physiological effects on the mind and body.

titanium4motion

[Obieone]

Okay ... now I just don't know anymore ...... !!

Obieone

[Lizbv]

I think each situation is different and you must monitor what works for you. Keep a close eye on your sore as well as other potential pressure areas. Being in bed all the time is not healthy overall, but depending on WHERE the sore is and WHAT is causing it is the biggest issue. And, if you can keep pressure completely off the sore and at minimum in other areas. healing sores is like a game. these studies, I think some of these phd type people need something to do to look important to us lowly sci lolol.

With a sore you need high protien diet, correct wound cleansing practices, good debreeding and skin growth medications, no pressure, and a practical, patient positive type mindset.

[sjean423]

I would feel the exact LOCATION of the sore would make a big difference here.

[Broknwing]

From my experience mine healed A LOT faster once I was back up & doing things...Now, I DID have a wound vac on it, but even the down time w/vac healed slower than the up time w/vac....

[rybread]

I have one on my left ischium right now that I've tried to stay up on but it still gets worse, no matter how many weight shifts I do. I can't even put my head up in bed too far for too long without it making a difference. I'm just now waiting for my surgeon to go ahead with the flap to get it healed since it is all the way to the bone.