What is the role of TPE in management of patients at risk or with pressure ulcer as of 2012? Developing French guidelines for clinical practice

Abstract

Introduction: Pressure ulcer (PU) is a common complication in chronic affection, especially neurological disorders and diseases commonly diagnosed in the elderly. For a long period of time, the prevention of skin lesions was taught only in an empirical manner. The development of therapeutic patient education (TPE) sheds a new light on care management for patients with chronic pathologies.

Objectives: Determine the place of TPE in persons at risk of and/or already suffering from pressure ulcer (PU) as of 2012.

Methods: The methodology used is the one promoted by SOFMER, including: a systematic review of the literature with a query of the PASCAL Biomed, PubMed and Cochrane Library databases for data from 2000 through 2010; a compendium of prevailing professional practices and advice from a committee of experts.

Results: The review of the literature found six studies including four controlled trials in patients with chronic neurological impairments (most of them with spinal cord injury). No studies were found regarding the elderly. The level of evidence for efficacy in persons with spinal cord injury (SCI) is moderate. The clinical practice study focuses on programs currently underway, dedicated to SCI patients or elderly populations.

Discussion: The approach proposed through TPE has its role in a strategy aimed at preventing PU in persons at chronic risk of developing PU. The educational objectives and techniques used must be adapted to the clinical and psychological context and are debated in this review. The co-construction of programs, recommended in the official texts on therapeutic education in France, should help to tailor these programs to the patients' needs.

Conclusion: TPE is relevant in care management or prevention of PU in persons at chronic risk, patients with spinal cord injury (Grade B) or elderly subjects (Grade C).