{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T02:45:05Z","timestamp":1794537905448,"version":"4.9.1"},"reference-count":72,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Spinal Cord"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Study design<\/jats:title>\n            <jats:p>Systematic scoping review.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Objectives<\/jats:title>\n            <jats:p>Pressure injuries (PI) are a serious but mostly preventable complication associated with living with spinal cord injuries (SCI). This review aims to identify and summarize evidence concerning self-managed digital technologies for preventing PI in the SCI population.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A systematic search was performed across seven databases\u2014Embase, Medline, PsycInfo, Web of Science, Scopus, CENTRAL, and CINAHL. To be eligible, studies had to be peer-reviewed and report original findings on self-managed digital technologies for PI prevention in adults (\u226518 years) with SCI. Supplementary searches were conducted using Google Scholar, PEDro, and citation tracking to locate relevant studies not identified by the systematic search. Data from the included studies were extracted and synthesized.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The systematic search identified 9797 unique studies. After screening and excluding 8939 records at the title-and-abstract level, 858 full-text records were assessed, and 12 met the inclusion criteria. The included studies fell into categories: (i) technology-driven feedback systems that provide real-time pressure distribution data and (ii) digital self-management and educational systems aimed at improving adherence to PI-preventive measures. Feedback systems were associated with improved pressure-relieving behaviours, though adherence to reminder-based interventions remained a challenge. Digital self-management tools were shown to enhance knowledge and confidence related to PI prevention.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Self-managed digital technologies increased awareness, confidence, and engagement in pressure relief behaviours among individuals with SCI. However, their direct impact on PI prevention remains inconclusive. Difficulties relating to adherence indicate that such technologies should complement, rather than replace, traditional prevention strategies.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1038\/s41393-025-01113-w","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T12:44:15Z","timestamp":1755521055000},"page":"492-498","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Self-managed digital technologies for pressure injury prevention in individuals with spinal cord injury: a systematic scoping review"],"prefix":"10.1038","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1468-133X","authenticated-orcid":false,"given":"Samuel David","family":"Williamson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8533-9132","authenticated-orcid":false,"given":"Maria Zofia","family":"Geisler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1119-7315","authenticated-orcid":false,"given":"Randi Kj\u00e6r","family":"Steensgaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5826-4469","authenticated-orcid":false,"given":"Kn\u00e6rke","family":"S\u00f8gaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f8ren Steen","family":"Nielsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Line Trine","family":"Dalsgaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie Lykkegaard","family":"Ravn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,18]]},"reference":[{"key":"1113_CR1","unstructured":"Kottner J, Worsley P, Brienza D. Pressure ulcers\/injuries: definition and etiology. In: Prevention and treatment of pressure ulcers\/injuries: clinical practice guideline. The international guideline. 4th Ed. 2025. https:\/\/www.internationalguideline.com\/. Accessed 14 Aug 2025."},{"key":"1113_CR2","doi-asserted-by":"publisher","first-page":"103546","DOI":"10.1016\/j.ijnurstu.2020.103546","volume":"105","author":"Z Li","year":"2020","unstructured":"Li Z, Lin F, Thalib L, Chaboyer W. Global prevalence and incidence of pressure injuries in hospitalised adult patients: a systematic review and meta-analysis. Int J Nurs Stud. 2020;105:103546.","journal-title":"Int J Nurs Stud"},{"key":"1113_CR3","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-020-03369-0","volume":"21","author":"WS Shiferaw","year":"2020","unstructured":"Shiferaw WS, Akalu TY, Mulugeta H, Aynalem YA. The global burden of pressure ulcers among patients with spinal cord injury: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2020;21:334.","journal-title":"BMC Musculoskelet Disord"},{"key":"1113_CR4","first-page":"34","volume":"60","author":"A Gefen","year":"2014","unstructured":"Gefen A. Tissue changes in patients following spinal cord injury and implications for wheelchair cushions and tissue loading: a literature review. Ostomy Wound Manage. 2014;60:34\u201345.","journal-title":"Ostomy Wound Manage"},{"key":"1113_CR5","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.3390\/jpm12071130","volume":"12","author":"NM Vecin","year":"2022","unstructured":"Vecin NM, Gater DR. Pressure injuries and management after spinal cord injury. J Pers Med. 2022;12:1130.","journal-title":"J Pers Med"},{"key":"1113_CR6","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1179\/2045772314Y.0000000234","volume":"38","author":"AN Dana","year":"2015","unstructured":"Dana AN, Bauman WA. Bacteriology of pressure ulcers in individuals with spinal cord injury: What we know and what we should know. J Spinal Cord Med. 2015;38:147\u201360.","journal-title":"J Spinal Cord Med"},{"key":"1113_CR7","first-page":"13","volume":"26","author":"S Lyons","year":"2009","unstructured":"Lyons S, Sorenson M. Quality of life in spinal cord injury patients with pressure ulcers. SCI Nurs. 2009;26:13\u20138.","journal-title":"SCI Nurs"},{"key":"1113_CR8","doi-asserted-by":"publisher","first-page":"2312","DOI":"10.1016\/j.apmr.2014.08.003","volume":"95","author":"D Lala","year":"2014","unstructured":"Lala D, Dumont FS, Leblond J, Houghton PE, Noreau L. Impact of pressure ulcers on individuals living with a spinal cord injury. Arch Phys Med Rehabil. 2014;95:2312\u20139.","journal-title":"Arch Phys Med Rehabil"},{"key":"1113_CR9","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.jtv.2023.11.009","volume":"33","author":"K Soegaard","year":"2024","unstructured":"Soegaard K, Sig JR, Nielsen C, Verhaeghe S, Beeckman D, Biering-S\u00f8rensen F, et al. \u201cI am just trying to live a life!\u201d \u2013a qualitative study of the lived experience of pressure ulcers in people with spinal cord injuries. J Tissue Viability. 2024;33:50\u20139.","journal-title":"J Tissue Viability"},{"key":"1113_CR10","first-page":"111","volume":"14","author":"MB Harding-Okimoto","year":"1997","unstructured":"Harding-Okimoto MB. Pressure ulcers, self-concept and body image in spinal cord injury patients. SCI Nurs. 1997;14:111\u20137.","journal-title":"SCI Nurs"},{"key":"1113_CR11","first-page":"225","volume":"13","author":"DK Langemo","year":"2000","unstructured":"Langemo DK, Melland H, Hanson D, Olson B, Hunter S. The lived experience of having a pressure ulcer: a qualitative analysis. Adv Skin Wound Care. 2000;13:225\u201335.","journal-title":"Adv Skin Wound Care"},{"key":"1113_CR12","doi-asserted-by":"publisher","first-page":"123","DOI":"10.15386\/mpr-2531","volume":"96","author":"E Roussou","year":"2023","unstructured":"Roussou E, Fasoi G, Stavropoulou A, Kelesi M, Vasilopoulos G, Gerogianni G, et al. Quality of life of patients with pressure ulcers: a systematic review. Med Pharm Rep. 2023;96:123\u201330.","journal-title":"Med Pharm Rep"},{"key":"1113_CR13","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1086\/502542","volume":"26","author":"N Graves","year":"2005","unstructured":"Graves N, Birrell F, Whitby M. Effect of pressure ulcers on length of hospital stay. Infect Control Hosp Epidemiol. 2005;26:293\u20137.","journal-title":"Infect Control Hosp Epidemiol"},{"key":"1113_CR14","doi-asserted-by":"publisher","first-page":"1264","DOI":"10.1111\/jocn.17149","volume":"34","author":"C Tai","year":"2024","unstructured":"Tai C, Wang J, Lo S, Tsay S, Yang C, O Yang AC, et al. Incidence, prevalence, and medical costs of pressure injuries in Taiwan from 2001 to 2015: results of a retrospective cohort study. J Clin Nurs. 2024;34:1264\u201376.","journal-title":"J Clin Nurs"},{"key":"1113_CR15","doi-asserted-by":"publisher","first-page":"1770","DOI":"10.1016\/j.apmr.2011.05.024","volume":"92","author":"JS Krause","year":"2011","unstructured":"Krause JS, Saunders LL. Health, secondary conditions, and life expectancy after spinal cord injury. Arch Phys Med Rehabil. 2011;92:1770\u20135.","journal-title":"Arch Phys Med Rehabil"},{"key":"1113_CR16","doi-asserted-by":"publisher","first-page":"e000409","DOI":"10.1136\/bmjoq-2018-000409","volume":"8","author":"J Wood","year":"2019","unstructured":"Wood J, Brown B, Bartley A, Margarida Batista Cust\u00f3dio Cavaco A, Roberts AP, Santon K, et al. Reducing pressure ulcers across multiple care settings using a collaborative approach. BMJ Open Qual. 2019;8:e000409.","journal-title":"BMJ Open Qual"},{"key":"1113_CR17","unstructured":"European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Interventions for Prevention and Treatment of Pressure Injuries. In: Prevention and treatment of pressure ulcers\/injuries: clinical practice guideline. The international guideline. 3rd Ed. https:\/\/www.internationalguideline.com\/2019. Accessed 14 Aug 2025."},{"key":"1113_CR18","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1682\/JRRD.2014.02.0064","volume":"52","author":"JY Tung","year":"2015","unstructured":"Tung JY, Stead B, Mann W, Pham B, Popovic MR. Assistive technologies for self-managed pressure ulcer prevention in spinal cord injury: a scoping review. J Rehabil Res Dev. 2015;52:131\u201346.","journal-title":"J Rehabil Res Dev"},{"key":"1113_CR19","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1038\/s41393-022-00841-7","volume":"61","author":"S Fryer","year":"2023","unstructured":"Fryer S, Caggiari S, Major D, Bader DL, Worsley PR. Continuous pressure monitoring of inpatient spinal cord injured patients: implications for pressure ulcer development. Spinal Cord. 2023;61:111\u20138.","journal-title":"Spinal Cord"},{"key":"1113_CR20","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1097\/01.WON.0000308620.78884.88","volume":"35","author":"CA Padula","year":"2008","unstructured":"Padula CA, Osborne E, Williams J. Prevention and early detection of pressure ulcers in hospitalized patients. J Wound Ostomy Continence Nurs. 2008;35:66\u201375.","journal-title":"J Wound Ostomy Continence Nurs"},{"key":"1113_CR21","doi-asserted-by":"publisher","first-page":"467","DOI":"10.7326\/M18-0850","volume":"169","author":"AC Tricco","year":"2018","unstructured":"Tricco AC, Lillie E, Zarin W, O\u2019Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169:467\u201373.","journal-title":"Ann Intern Med"},{"key":"1113_CR22","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-020-01542-z","volume":"10","author":"ML Rethlefsen","year":"2021","unstructured":"Rethlefsen ML, Kirtley S, Waffenschmidt S, Ayala AP, Moher D, Page MJ, et al. PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews. Syst Rev. 2021;10:39.","journal-title":"Syst Rev"},{"key":"1113_CR23","doi-asserted-by":"crossref","unstructured":"Wohlin C. Guidelines for snowballing in systematic literature studies and a replication in software engineering. In: Shepperd MJ, Hall T, Myrtveit I (eds). Proceedings of the 18th international conference on evaluation and assessment in software engineering. Association for Computing Machinery (ACM), New York, 2014. pp 1\u201310.","DOI":"10.1145\/2601248.2601268"},{"key":"1113_CR24","unstructured":"Google Scholar. Google Scholar. 2025. https:\/\/scholar.google.com."},{"key":"1113_CR25","unstructured":"Physiotherapy Evidence Database (PEDro). PEDro - the Physiotherapy Evidence Database. 2025. https:\/\/pedro.org.au."},{"key":"1113_CR26","unstructured":"Covidence systematic review software. Melbourne, Australia: Veritas Health Innovation. 2025. https:\/\/www.covidence.org."},{"key":"1113_CR27","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1136\/ebmed-2016-110401","volume":"21","author":"MH Murad","year":"2016","unstructured":"Murad MH, Asi N, Alsawas M, Alahdab F. New evidence pyramid. Evid Based Med. 2016;21:125\u20137.","journal-title":"Evid Based Med."},{"key":"1113_CR28","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1046\/j.1365-2702.2003.00662.x","volume":"12","author":"D Evans","year":"2003","unstructured":"Evans D. Hierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions. J Clin Nurs. 2003;12:77\u201384.","journal-title":"J Clin Nurs"},{"key":"1113_CR29","doi-asserted-by":"publisher","first-page":"e1230","DOI":"10.1002\/cl2.1230","volume":"18","author":"NR Haddaway","year":"2022","unstructured":"Haddaway NR, Page MJ, Pritchard CC, McGuinness LA. PRISMA2020: an R package and Shiny app for producing PRISMA 2020\u2010compliant flow diagrams, with interactivity for optimised digital transparency and open synthesis. Campbell Syst Rev. 2022;18:e1230.","journal-title":"Campbell Syst Rev."},{"key":"1113_CR30","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1038\/s41393-020-0522-7","volume":"59","author":"M Hubli","year":"2021","unstructured":"Hubli M, Zemp R, Albisser U, Camenzind F, Leonova O, Curt A, et al. Feedback improves compliance of pressure relief activities in wheelchair users with spinal cord injury. Spinal Cord. 2021;59:175\u201384.","journal-title":"Spinal Cord"},{"key":"1113_CR31","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1080\/10790268.2022.2107352","volume":"46","author":"SA Sundaram","year":"2023","unstructured":"Sundaram SA, Chung CS, Gebrosky B, Brown J, Grindle GG, Deepak N, et al. Participatory action design and engineering of a manual wheelchair virtual coach including in-home and community usage. J Spinal Cord Med. 2023;46:546\u201359.","journal-title":"J Spinal Cord Med"},{"key":"1113_CR32","doi-asserted-by":"publisher","first-page":"e49813","DOI":"10.2196\/49813","volume":"10","author":"TL Vos-Draper","year":"2023","unstructured":"Vos-Draper TL, Morrow MMB, Ferguson JE, Mathiowetz VG. Effects of real-time pressure map feedback on confidence in pressure management in wheelchair users with spinal cord injury: pilot intervention study. JMIR Rehabil Assist Technol. 2023;10:e49813.","journal-title":"JMIR Rehabil Assist Technol"},{"key":"1113_CR33","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1080\/10400435.2020.1862938","volume":"34","author":"BM Goodwin","year":"2022","unstructured":"Goodwin BM, Olney CM, Ferguson JE, Hansen AH, Eddy B, Goldish G, et al. Visualization of user interactions with a pressure mapping mobile application for wheelchair users at risk for pressure injuries. Assist Technol. 2022;34:444\u201353.","journal-title":"Assist Technol"},{"key":"1113_CR34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1109\/JTEHM.2018.2842746","volume":"6","author":"A Moreau-Gaudry","year":"2018","unstructured":"Moreau-Gaudry A, Chenu O, Dang MV, Bosson JL, Hommel M, Demongeot J, et al. Reduction of prolonged excessive pressure in seated persons with paraplegia using wireless lingual tactile feedback: a randomized controlled trial. IEEE J Transl Eng Health Med. 2018;6:1\u201311.","journal-title":"IEEE J Transl Eng Health Med"},{"key":"1113_CR35","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1080\/10400435.2010.483644","volume":"22","author":"YS Yang","year":"2010","unstructured":"Yang YS, Chou YC, Hsu JJ, Chang JJ. Effects of audio feedback on sitting behaviors of community-dwelling manual wheelchair users with spinal cord injuries. Assist Technol. 2010;22:79\u201386.","journal-title":"Assist Technol"},{"key":"1113_CR36","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/j.invent.2014.07.003","volume":"1","author":"M Hilgart","year":"2014","unstructured":"Hilgart M, Ritterband L, Baxter K, Alfano A, Ratliff C, Kinzie M, et al. Development and perceived utility and impact of a skin care internet intervention. Internet Interv. 2014;1:149\u201357.","journal-title":"Internet Interv"},{"key":"1113_CR37","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1038\/sc.2013.45","volume":"51","author":"BV Houlihan","year":"2013","unstructured":"Houlihan BV, Jette A, Friedman RH, Paasche-Orlow M, Ni P, Wierbicky J, et al. A pilot study of a telehealth intervention for persons with spinal cord dysfunction. Spinal Cord. 2013;51:715\u201320.","journal-title":"Spinal Cord"},{"key":"1113_CR38","doi-asserted-by":"publisher","first-page":"e14305","DOI":"10.2196\/14305","volume":"21","author":"MA Kryger","year":"2019","unstructured":"Kryger MA, Crytzer TM, Fairman A, Quinby EJ, Karavolis M, Pramana G, et al. The effect of the interactive mobile health and rehabilitation system on health and psychosocial outcomes in spinal cord injury: randomized controlled trial. J Med Internet Res. 2019;21:e14305.","journal-title":"J Med Internet Res"},{"key":"1113_CR39","first-page":"38","volume":"58","author":"J Schubart","year":"2012","unstructured":"Schubart J. An e-learning program to prevent pressure ulcers in adults with spinal cord injury: a pre- and post- pilot test among rehabilitation patients following discharge to home. Ostomy Wound Manage. 2012;58:38\u201349.","journal-title":"Ostomy Wound Manage"},{"key":"1113_CR40","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1016\/j.jtv.2024.06.013","volume":"33","author":"LQ Liu","year":"2024","unstructured":"Liu LQ, Deegan R, Dunne H, Knight SL, Allan HT, Gall A. A pilot study for testing feasibility and preliminary influence of early intervention using text messaging for pressure ulcer prevention in individuals with spinal cord injury. J Tissue Viability. 2024;33:666\u201371.","journal-title":"J Tissue Viability"},{"key":"1113_CR41","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1080\/09638288.2020.1771780","volume":"44","author":"T Shirai","year":"2022","unstructured":"Shirai T, Bulandres P, Choi JA, D\u2019Ortenzio D, Moon N, Musselman K, et al. The use of a mobile educational tool on pressure injury education for individuals living with spinal cord injury\/disease: a qualitative research study. Disabil Rehabil. 2022;44:468\u201377.","journal-title":"Disabil Rehabil"},{"key":"1113_CR42","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1177\/0269215516660855","volume":"31","author":"AM Cogan","year":"2017","unstructured":"Cogan AM, Blanchard J, Garber SL, Vigen CL, Carlson M, Clark FA. Systematic review of behavioral and educational interventions to prevent pressure ulcers in adults with spinal cord injury. Clin Rehabil. 2017;31:871\u201380.","journal-title":"Clin Rehabil"},{"key":"1113_CR43","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1016\/j.pmrj.2014.11.014","volume":"7","author":"SL Groah","year":"2015","unstructured":"Groah SL, Schladen M, Pineda CG, Hsieh CJ. Prevention of pressure ulcers among people with spinal cord injury: a systematic review. PM R. 2015;7:613\u201336.","journal-title":"PM R"},{"key":"1113_CR44","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.apmr.2008.08.212","volume":"90","author":"MA Regan","year":"2009","unstructured":"Regan MA, Teasell RW, Wolfe DL, Keast D, Mortenson WB, Aubut JAL. A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury. Arch Phys Med Rehabil. 2009;90:213\u201331.","journal-title":"Arch Phys Med Rehabil"},{"key":"1113_CR45","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1016\/j.jtv.2023.02.005","volume":"32","author":"K Soegaard","year":"2023","unstructured":"Soegaard K, Sollie M, Beeckman D, Biering-S\u00f8rensen F, Ahm-S\u00f8rensen J. Interventions, stakeholders, and organisation related to pressure ulcer prevention for individuals with spinal cord injuries in transition from hospital to home - a scoping review. J Tissue Viability. 2023;32:194\u2013205.","journal-title":"J Tissue Viability"},{"key":"1113_CR46","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1007\/s40141-016-0140-7","volume":"4","author":"TL Vos-Draper","year":"2016","unstructured":"Vos-Draper TL, Morrow MMB. Seating-related pressure injury prevention in spinal cord injury: a review of compensatory technologies to improve in-seat movement behavior. Curr Phys Med Rehabil Rep. 2016;4:320\u20138.","journal-title":"Curr Phys Med Rehabil Rep"},{"key":"1113_CR47","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1038\/s41393-018-0138-3","volume":"56","author":"JS Baron","year":"2018","unstructured":"Baron JS, Sullivan KJ, Swaine JM, Aspinall A, Jaglal S, Presseau J, et al. Self-management interventions for skin care in people with a spinal cord injury: part 1\u2014a systematic review of intervention content and effectiveness. Spinal Cord. 2018;56:823\u201336.","journal-title":"Spinal Cord"},{"key":"1113_CR48","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1179\/2045772314Y.0000000226","volume":"37","author":"LQ Liu","year":"2014","unstructured":"Liu LQ, Moody J, Traynor M, Dyson S, Gall A. A systematic review of electrical stimulation for pressure ulcer prevention and treatment in people with spinal cord injuries. J Spinal Cord Med. 2014;37:703\u201318.","journal-title":"J Spinal Cord Med"},{"key":"1113_CR49","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1038\/s41393-017-0054-y","volume":"56","author":"RA Atkinson","year":"2018","unstructured":"Atkinson RA, Cullum NA. Interventions for pressure ulcers: a summary of evidence for prevention and treatment. Spinal Cord. 2018;56:186\u201398.","journal-title":"Spinal Cord"},{"key":"1113_CR50","doi-asserted-by":"publisher","first-page":"104014","DOI":"10.1016\/j.ijnurstu.2021.104014","volume":"122","author":"M Engelen","year":"2021","unstructured":"Engelen M, van Dulmen S, Vermeulen H, de Laat E, van Gaal B. The content and effectiveness of self-management support interventions for people at risk of pressure ulcers: a systematic review. Int J Nurs Stud. 2021;122:104014.","journal-title":"Int J Nurs Stud"},{"key":"1113_CR51","first-page":"CD012006","volume":"2","author":"T O\u2019Connor","year":"2021","unstructured":"O\u2019Connor T, Moore ZE, Patton D. Patient and lay carer education for preventing pressure ulceration in at-risk populations. Cochrane Database Syst Rev. 2021;2:CD012006.","journal-title":"Cochrane Database Syst Rev"},{"key":"1113_CR52","doi-asserted-by":"publisher","first-page":"e15818","DOI":"10.2196\/15818","volume":"8","author":"M Fiordelli","year":"2020","unstructured":"Fiordelli M, Zanini C, Amann J, Scheel-Sailer A, Brach M, Stucki G, et al. Selecting evidence-based content for inclusion in self-management apps for pressure injuries in individuals with spinal cord injury: participatory design study. JMIR Mhealth Uhealth. 2020;8:e15818.","journal-title":"JMIR Mhealth Uhealth"},{"key":"1113_CR53","doi-asserted-by":"publisher","first-page":"020927","DOI":"10.1115\/1.4033277","volume":"10","author":"A Khan","year":"2016","unstructured":"Khan A, Phung N. Undergraduate research in assistive technology: design and development of a preventive weight shifting app to reduce the risk of pressure ulcers in wheelchair bound patients with spinal cord injuries (Phase 1). J Med Device. 2016;10:020927.","journal-title":"J Med Device"},{"key":"1113_CR54","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.jtv.2013.05.002","volume":"22","author":"O Chenu","year":"2013","unstructured":"Chenu O, Vuillerme N, Bucki M, Diot B, Cannard F, Payan Y. TexiCare: an innovative embedded device for pressure ulcer prevention. Preliminary results with a paraplegic volunteer. J Tissue Viability. 2013;22:83\u201390.","journal-title":"J Tissue Viability"},{"key":"1113_CR55","doi-asserted-by":"publisher","first-page":"2565","DOI":"10.1080\/17483107.2023.2293876","volume":"19","author":"H Oh","year":"2024","unstructured":"Oh H, Hye Y, Pontis S. Understanding individuals with spinal cord injury\u2019s self-care practices: a technology probe study to promote pressure relief adherence. Disabil Rehabil Assist Technol. 2024;19:2565\u201379.","journal-title":"Disabil Rehabil Assist Technol"},{"key":"1113_CR56","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1007\/s10880-006-9032-9","volume":"13","author":"JL Rowland","year":"2006","unstructured":"Rowland JL, White GW, Wyatt DA. Analysis of an intervention to reduce or prevent secondary conditions for people with spinal cord injuries. J Clin Psychol Med Settings. 2006;13:261\u20139.","journal-title":"J Clin Psychol Med Settings"},{"key":"1113_CR57","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1038\/sc.2012.6","volume":"50","author":"CAJ Smit","year":"2012","unstructured":"Smit CAJ, Haverkamp GLG, de Groot S, Stolwijk-Swuste JM, Janssen TWJ. Effects of electrical stimulation-induced gluteal versus gluteal and hamstring muscles activation on sitting pressure distribution in persons with a spinal cord injury. Spinal Cord. 2012;50:590\u20134.","journal-title":"Spinal Cord"},{"key":"1113_CR58","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.1682\/JRRD.2012.07.0134","volume":"50","author":"CAJ Smit","year":"2013","unstructured":"Smit CAJ, Legemate KJA, de Koning A, de Groot S, Stolwijk-Swuste JM, Janssen TWJ. Prolonged electrical stimulation-induced gluteal and hamstring muscle activation and sitting pressure in spinal cord injury: effect of duty cycle. J Rehabil Res Dev. 2013;50:1035\u201346.","journal-title":"J Rehabil Res Dev"},{"key":"1113_CR59","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1002\/mus.21060","volume":"38","author":"LD Duffell","year":"2008","unstructured":"Duffell LD, Donaldson N, de N, Perkins TA, Rushton DN, Hunt KJ, et al. Long\u2010term intensive electrically stimulated cycling by spinal cord\u2013injured people: effect on muscle properties and their relation to power output. Muscle Nerve. 2008;38:1304\u201311.","journal-title":"Muscle Nerve"},{"key":"1113_CR60","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1097\/PHM.0000000000001929","volume":"101","author":"T Barton","year":"2022","unstructured":"Barton T, Low DA, Thijssen DHJ, Romviel S, Sloots M, Smit CAJ, et al. Twelve-week daily gluteal and hamstring electrical stimulation improves vascular structure and function, limb volume, and sitting pressure in spinal cord injury. Am J Phys Med Rehabil. 2022;101:913\u20139.","journal-title":"Am J Phys Med Rehabil"},{"key":"1113_CR61","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1007\/BF02458039","volume":"31","author":"A Stefanovska","year":"1993","unstructured":"Stefanovska A, Vodovnik L, Benko H, Turk R. Treatment of chronic wounds by means of electric and electromagnetic fields. Med Biol Eng Comput. 1993;31:213\u201320.","journal-title":"Med Biol Eng Comput"},{"key":"1113_CR62","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1152\/japplphysiol.00661.2010","volume":"110","author":"S Gyawali","year":"2011","unstructured":"Gyawali S, Solis L, Chong SL, Curtis C, Seres P, Kornelsen I, et al. Intermittent electrical stimulation redistributes pressure and promotes tissue oxygenation in loaded muscles of individuals with spinal cord injury. J Appl Physiol. 2011;110:246\u201355.","journal-title":"J Appl Physiol"},{"key":"1113_CR63","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1016\/j.apmr.2009.12.026","volume":"91","author":"PE Houghton","year":"2010","unstructured":"Houghton PE, Campbell KE, Fraser CH, Harris C, Keast DH, Potter PJ, et al. Electrical stimulation therapy increases rate of healing of pressure ulcers in community-dwelling people with spinal cord injury. Arch Phys Med Rehabil. 2010;91:669\u201378.","journal-title":"Arch Phys Med Rehabil"},{"key":"1113_CR64","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/oti.174","volume":"10","author":"JM Pellerito","year":"2003","unstructured":"Pellerito JM. The effects of traditional and computer\u2010aided instruction on promoting independent skin care in adults with paraplegia. Occup Ther Int. 2003;10:1\u201319.","journal-title":"Occup Ther Int"},{"key":"1113_CR65","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1080\/03091902.2021.1936238","volume":"45","author":"N Md Nadzri","year":"2021","unstructured":"Md Nadzri N, Hamzaid NA, Chung TY. Design and development of a wheelchair seating pressure relief reminder system for pressure ulcer prevention among paraplegics. J Med Eng Technol. 2021;45:574\u201381.","journal-title":"J Med Eng Technol"},{"key":"1113_CR66","doi-asserted-by":"publisher","first-page":"e22452","DOI":"10.2196\/22452","volume":"8","author":"J Amann","year":"2020","unstructured":"Amann J, Fiordelli M, Scheel-Sailer A, Brach M, Rubinelli S. Opportunities and challenges of a self-management app to support people with spinal cord injury in the prevention of pressure injuries: qualitative study. JMIR Mhealth Uhealth. 2020;8:e22452.","journal-title":"JMIR Mhealth Uhealth"},{"key":"1113_CR67","doi-asserted-by":"publisher","first-page":"e18018","DOI":"10.2196\/18018","volume":"8","author":"J Amann","year":"2020","unstructured":"Amann J, Fiordelli M, Brach M, Bertschy S, Scheel-Sailer A, Rubinelli S. Co-designing a self-management app prototype to support people with spinal cord injury in the prevention of pressure injuries: mixed methods study. JMIR Mhealth Uhealth. 2020;8:e18018.","journal-title":"JMIR Mhealth Uhealth"},{"key":"1113_CR68","first-page":"205566832312118","volume":"10","author":"K Jordan","year":"2023","unstructured":"Jordan K, Vos-Draper T, Morrow M, Sonenblum S. The usability of two mobile health assistive technologies for wheelchair-related in-seat movement and pressure. J Rehabil Assist Technol Eng. 2023;10:20556683231211808.","journal-title":"J Rehabil Assist Technol Eng"},{"key":"1113_CR69","doi-asserted-by":"crossref","unstructured":"Motahar T, Ghosh I, Wiese J. Identifying factors that inhibit self-care behavior among individuals with severe spinal cord injury. In: CHI conference on human factors in computing systems. New York, NY, USA: ACM; 2022. pp. 1\u201316.","DOI":"10.1145\/3491102.3517658"},{"key":"1113_CR70","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1080\/10790268.2019.1570437","volume":"42","author":"CM Olney","year":"2019","unstructured":"Olney CM, Vos-Draper T, Egginton J, Ferguson J, Goldish G, Eddy B, et al. Development of a comprehensive mobile assessment of pressure (CMAP) system for pressure injury prevention for veterans with spinal cord injury. J Spinal Cord Med. 2019;42:685\u201394.","journal-title":"J Spinal Cord Med"},{"key":"1113_CR71","doi-asserted-by":"crossref","unstructured":"Prensky, M. Digital natives, digital immigrants part 1. On the Horizon. 2001;9:1\u20136.","DOI":"10.1108\/10748120110424816"},{"key":"1113_CR72","doi-asserted-by":"publisher","first-page":"e0240600","DOI":"10.1371\/journal.pone.0240600","volume":"15","author":"A Conti","year":"2020","unstructured":"Conti A, Dimonte V, Rizzi A, Clari M, Mozzone S, Garrino L, et al. Barriers and facilitators of education provided during rehabilitation of people with spinal cord injuries: a qualitative description. PLoS ONE. 2020;15:e0240600.","journal-title":"PLoS ONE"}],"container-title":["Spinal Cord"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41393-025-01113-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41393-025-01113-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41393-025-01113-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T16:12:08Z","timestamp":1757088728000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41393-025-01113-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,18]]},"references-count":72,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["1113"],"URL":"https:\/\/doi.org\/10.1038\/s41393-025-01113-w","relation":{},"ISSN":["1362-4393","1476-5624"],"issn-type":[{"value":"1362-4393","type":"print"},{"value":"1476-5624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,18]]},"assertion":[{"value":"9 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 July 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 July 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 August 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}