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This Journal Club Podcast is brought to you by Association of Academic Physiatrists and features research published in the American Journal of Physical Medicine & Rehabilitation.

Dr. Sunil Sabharwal interviews Dr. Gerben DeJong, author of the article entitled "Factors Associated with Pressure Ulcer in Spinal Cord Injury Rehabilitation".

Objective:
The aim of this study was to identify patient and clinical factors most strongly associated with a spinal cord injury patient's risk for developing a pressure ulcer (PU) during rehabilitation.

Design:
This is a prospective observational cohort study conducted at an urban rehabilitation hospital-based specialized spinal cord injury center. The main outcome measure was the onset of a stage 2 or higher PU.

Results:
Study patients (N = 159) with new (n = 66) and patients with earlier (n = 99) spinal injuries had identical rates at which they acquired a new PU (stage >=2) in rehabilitation-13.1%. The patients who came to rehabilitation with a PU or myocutaneous flap exhibited a higher rate of developing yet another PU while in rehabilitation (30.2%) than those who came to rehabilitation without an existing PU or flap (6.9%). Logistic regression analysis identified two variables that best predicted a patient's risk at admission for developing a PU during rehabilitation (c = 0.77)-entering rehabilitation with a PU and admission Functional Independence Measure transfers score of less than 3.5.

Conclusions:
The greatest risk of developing a new PU in rehabilitation is being admitted with an existing PU followed by admission Functional Independence Measure transfers score of less than 3.5. Using these two variables, one can develop a patient PU risk algorithm at admission that can alert clinicians for the need to enhance vigilance, skin monitoring, and early patient education.

Contributor:
Gerben DeJong, PhD, FACRM is a senior fellow and director of the Center for Post-acute Innovation and Research at the MedStar National Rehabilitation Network (MedStar NRH) in Washington, DC. Prior to rejoining MedStar NRH in late 2004, Dr. DeJong served a two-year stint with the University of Florida as a Research Professor in the Department of Health Services Research, Management and Policy. Until 2001, Dr. DeJong served for 16 years (1985-2001) as the Director of Research for the MedStar National Rehabilitation Network in Washington, DC, and as the founding director of the network's Center for Health & Disability Research. Dr. DeJong has conducted several large multi-center health outcome studies. He is the author or co-author of more than 250 papers on health policy, income maintenance, disability, post-acute rehabilitation, and health outcomes. He has been an avid student of the American post-acute health care system particularly its growth, development, and consolidation across the various post-acute industries. Dr. DeJong served as President of the American Congress of Rehabilitation Medicine in 2006-07. In 1985, he received the Licht Award for Excellence in Scientific Writing from the American Congress of Rehabilitation Medicine and, in 1998, he received the organization's highest award, the Gold Key Award.