Self-management interventions for skin care in people with a spinal cord injury: part 1-a systematic review of intervention content and effectiveness

Abstract

Study design: Systematic review.

Objectives: To review the content and effectiveness of skin care self-management interventions for people with SCI.

Setting: International.

Methods: We searched electronic bibliographic databases, trial registers, and relevant reference lists. Eligibility criteria for the reviews of intervention content and effectiveness were identical with the exception of study design. The review of intervention content included non-randomized and randomized controlled trials (RCTs). The review of effectiveness included RCTs. A Behavior Change Technique (BCT) taxonomy of 93 BCTs was used to code intervention content. Intervention effects on outcomes of interest are summarized descriptively. Effect sizes were calculated, and the Cochrane risk of bias tool applied.

Results: In all, 15 studies testing 17 interventions were included in the review of intervention content. Interventions in these studies included 28 BCTs. The most common were "instructions on how to perform behavior" (16 interventions), "credible source" (12 interventions), and "social support (unspecified)" (9 interventions). Ten RCTs were included in the review of intervention effectiveness and they measured knowledge, self-efficacy, and skills relating to skin care/pressure ulcer (PU) prevention, skin care behaviors, skin status (PU prevalence, severity, and time to PU), and health-care utilization for skin problems. Evidence to support intervention effects on these outcomes was limited, particularly for clinical outcomes. Risk of bias assessments was often inconclusive due to poor reporting.

Conclusions: There is potential to design SCI skin care interventions that include currently untested BCTs. Further research and better consistency in outcome measurements and reporting are required to synthesize evidence on effectiveness.

Fig. 1

PRISMA flow diagram. Systematic review of skin care self-management interventions for people with SCI

Fig. 2

Behavior change techniques coded to the 17 interventions reviewed

Fig. 3

Risk of bias assessment results across the 10 randomized controlled trials reviewed. Notes: High high risk of bias, low low risk of bias, Uncertain unclear risk of bias. The “unclear” category was used where there was insufficient detail for a conclusion to be reached, or where there was no published/registered study protocol available (item on selective outcome reporting). A decision about the selective outcome reporting item was reached by comparing outcomes reported on to measures outlined in registered or published protocols. If a protocol was not available, this item was marked as “unclear”. In addition, items on blinding of outcomes were rated “not applicable” if skin care outcomes or pressure-ulcer-related outcomes were not measured