Veterans with spinal cord injury (VwSCI) are at high risk for pressure injury (PI). Risk factors for PI in VwSCI include lack of sensation below the level of injury, relative immobility, and poor gluteal muscle tone. The average added healthcare cost for a person with SCI with a pressure injury is estimated to be $70,000, and hospitalization may be required for weeks to months to heal the pressure injury. Furthermore, incurring a pressure injury can result in severe infection, limb loss, or even death. Preventative behavior to incurring a pressure injury is taught to the VwSCI during rehabilitation. Behaviors such as pressure reliefs every 15 minutes, turning every two hours when lying in bed, and conducting regular skin assessments are recommended for PI prevention. Most VwSCI are taught to use a mirror on a long handle for viewing at-risk seated areas (e.g., sacrum, ischial tuberosities, coccyx area, and trochanters) at least twice a day for evidence of skin changes. If the mirror user discovers a change in the skin, he/she is encouraged to completely offload that area. Many VwSCI live great distances from the VA SCI clinic thus healthcare providers could better advise Veterans to the appropriate pathway if they could view an image of the at-risk skin. The long term goal of this work is to help VwSCI prevent the progression and severity of an early detected pressure injury. The short term goals are to 1) provide VwSCI a more efficient and efficacious tool [In-Sight camera system] to examine their at-risk skin areas; and to 2) provide a secure and efficient communication process with their health care provider or skin specialist regarding areas of concern.
The first aim of the project will involve N=18 VwSCI (level C7 and below). During a first visit, Veterans will describe their current use of the long-handled mirror to conduct skin screening and will demonstrate their ability to see key locations with the mirror. They will also fill out the Assistive Device section of the QUEST 2.0 to provide their satisfaction with the long-handled mirror. The In-Sight camera system will be presented to the Veterans and they will be trained on how to use the system by the research nurse. The Veterans will then demonstrate their ability to see key locations with the camera system. Subjects will fill out the Assistive Device section of the QUEST 2.0 for the camera system and will provide feedback on how to improve the system. This feedback will be used by our engineering team to refine the camera system. During a second visit, the refined camera system will be retested by the same N=18 VwSCI using the same protocol. QUEST 2.0 device subscale scores will assist in quantifying improvements to the device during the refinement.
The second aim will use the refined camera system in at-home testing of N=6 VwSCI (level C7 and below). During a first visit to the Veteran's home, the Veteran will conduct the same testing with the long-handled mirror as described for Aim 1. The research nurse will train the Veteran on how to use the In-Sight camera system and the Veteran will use the system at home for 3 months. Veterans will send images weekly (using MyHealtheVet) to a wound care nurse at the Minneapolis VA SCI/D Center or more often if they find areas of concern. The research nurse will call Veterans weekly to determine if they are having any issues with the system and to provide feedback regarding the image quality (based on discussions with the wound care nurse). At the end of the study, the research nurse will return to the Veteran's home and the Veteran will demonstrate their use of the camera system and fill out the Assistive Device section of the QUEST 2.0. We expect to show that the camera system is preferred to the long-handled mirror and to establish the feasibility for a future clinical trial comparing different skin screening technologies.
There are more than 40,000 Veterans living with spinal cord injury (SCI) and most will have at least one serious pressure injury during their lifetime. An unchecked pressure injury interrupts normal daily living, often leading to days to months of hospitalization. Early intervention for a pressure injury can greatly modify the pressure injury and subsequent intervention trajectory. The objective of this project is to complete development of a camera system used for early detection of pressure injury for Veterans with SCI. The camera system will replace the current, inefficient method for conducting daily skin assessments using a long-handled mirror. The Veterans will be able to share skin assessment concerns, including images, with their provider using MyHealtheVet, a secure VA communication system, resulting in timely and effective early interventions, offsetting the devastating consequences of unchecked pressure injuries.
