Facilitators, Barriers and Knowledge of Self-Management Practices to Prevent Pressure Injury among Spinal-Cord Injury Patients in Rehabilitation Phase in South-West Nigeria

Evidence indicate that over 80% of patients with spinal cord injury (SCI) will develop pressure injuries (PI) at one point in a lifetime. Consequently,
clinical recommendations for PI prevention includes structured education at appropriate levels to persons with SCI and their care givers. In Nigeria,
PI is a common secondary medical complication associated with SCI and accounts for 1/4th of the total cost. Several studies a have targeted
knowledge and practice of care providers. We found a dearth of studies on self-management strategies of patients with SCI in rehabilitative phase
of the disease.
Aim of Study: To evaluate the facilitators, barriers and knowledge of self-management practices to prevent PI among community dwellers with SCI.
Methodology: A Survey of sixty (61) purposively selected patients with SCI. Patients were met at neurological and physiotherapy clinics in two
selected tertiary hospitals in south west Nigeria. Data were collected using a validated structured questionnaire (Correlation Coefficient 0.73) to
examine knowledge of risk factors and the self –management practices (repositioning and skin care practices). SPSS version 22 was used for data
analysis and hypotheses were tested at 5% level of significance.
Results: Respondents’ mean age was 40years and were more males (67.2%) than females (32.8%). There were 53(87.0%) paraplegics and
8(13.0%) quadriplegics. Of this 21(34.4%) have had pressure injury following discharge from hospital and 11(18.0%) still had PI at time of
study. Findings also showed that 35(57.4%) possess good knowledge of risk factors for PI and 31(50.8%) had poor knowledge of the selfmanagement
strategies (repositioning and skin care) to prevent PIs. However, practice was suboptimal, as 11(26.2%) never palpated skin for
changes; 33 (54.1%) have never inspected skin over bony prominences. Association between knowledge of self-management strategies and
actual practice was not statistically significant, as respondents with low knowledge also demonstrated poor practice (54.8%; χ2 =2.89, p=0.09).
Knowledge of risk factors and self-management practices were not significant (χ2 =3.31; p=0.07). Respondents with poor knowledge of risk
factors also exhibited poor practice (15; 57.7%). Multivariate analysis revealed that lack of motivation to perform self-care interventions was
the only significant predictor of the practice of self-management. Respondents who were motivated were twice more likely to have good selfmanagement
practice compared to those who were not motivated (OR = 2.17, 95% CI = 1.08 – 3.25, p = 0.03). Lack of knowledge about self-care
preventive measures (67.2%), and inadequate support from family caregivers (67.2%) hindered practice of self –management interventions.
Conclusion: There is need for a targeted individualized education and support to SCI patients prior to discharge to enhance patients’ self-efficacy.
The family caregivers should also be involved in this empowerment to ensure continual support of the patients at home. Periodic evaluation at
outpatients to strengthen patients’ self-management abilities is recommended.

Author(s): Rose Ekama Ilesanmi

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