{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:37:47Z","timestamp":1791362267081,"version":"4.3.1"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,1,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Pressure ulcer development is a common, serious complication after spinal cord injury (SCI). Although many biophysical agents are available for treatment, few randomized controlled trials of their efficacy have been done.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The study objective was to examine the efficacy of low-pressure pulsatile lavage treatment for stage III and IV pressure ulcers in people with SCI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>This study was a randomized controlled trial. Participants and assessors were unaware of intervention assignments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>This study was conducted in an SCI tertiary care center inpatient unit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Participants were 28 people with SCI and stage III and IV pelvic pressure ulcers; 14 participants each were randomly assigned to treatment and control (sham treatment) groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>Daily low-pressure pulsatile lavage treatment with 1 L of normal saline at 11 psi of pressure was applied to the treatment group along with standard dressing changes. The control group received only sham treatment and standard dressing changes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Linear and volume measurements of pressure ulcer dimensions were obtained weekly for 3 weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Statistical analysis with the t test revealed no statistically significant difference in demographics between groups. Random-coefficient models for analysis of linear and volume measurements revealed improvements over time for both groups. Time trend analysis revealed greater measurement decreases for the treatment group. Differences in rates of change (with 95% confidence intervals) for treatment and control groups, respectively, were: depth, \u22120.24 (0.09 to \u22120.58) cm\/wk; width, \u22120.16 (0.06 to \u22120.39) cm\/wk; length, \u22120.47 (0.18 to \u22121.12) cm\/wk; and volume, \u22120.33 (0.13 to \u22120.80) cm3\/wk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Limitations<\/jats:title><jats:p>Study limitations were small sample size and inclusion of only one site. Additionally, participants were not queried about their group assignments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Pulsatile lavage enhanced stage III and IV pelvic pressure ulcer healing rates in people with SCI relative to standard pressure ulcer treatment alone.<\/jats:p><\/jats:sec>","DOI":"10.2522\/ptj.20100349","type":"journal-article","created":{"date-parts":[[2011,9,24]],"date-time":"2011-09-24T08:54:17Z","timestamp":1316854457000},"page":"38-48","source":"Crossref","is-referenced-by-count":22,"title":["Pulsatile Lavage for the Enhancement of Pressure Ulcer Healing: A Randomized Controlled Trial"],"prefix":"10.1093","volume":"92","author":[{"given":"Chester H.","family":"Ho","sequence":"first","affiliation":[{"name":"C.H. Ho, MD, Division of Physical Medicine and Rehabilitation, Foothills Hospital, Calgary, Alberta, Canada. At the time of the study, Dr Ho's affiliations were Spinal Cord Injury Unit, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, and Department of Physical Medicine and Rehabilitation, School of Medicine, Case Western Reserve University, Cleveland, Ohio."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toula","family":"Bensitel","sequence":"additional","affiliation":[{"name":"T. Bensitel, MD, Cleveland Clinic, Cleveland, Ohio."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofeng","family":"Wang","sequence":"additional","affiliation":[{"name":"X. Wang, PhD, Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kath M.","family":"Bogie","sequence":"additional","affiliation":[{"name":"K.M. Bogie, DPhil, APT Center of Excellence, 151 AW\/APT, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106 (USA), and Department of Orthopedics and Biomedical Engineering, Case Western Reserve University."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"key":"2020010102180061800_B1","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1016\/S0003-9993(99)90250-2","article-title":"Medical complications during acute rehabilitation following spinal cord injury: current experience of the Model System","volume":"80","author":"Chen","year":"1999","journal-title":"Arch Phys Med Rehabil"},{"key":"2020010102180061800_B2","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/S0749-3797(18)30640-8","article-title":"A description of nonfatal spinal cord injury using a hospital-based registry","volume":"10","author":"Woodruff","year":"1994","journal-title":"Am J Prev Med"},{"key":"2020010102180061800_B3","first-page":"665","article-title":"Surveillance of spinal cord injuries in Utah, USA","volume":"32","author":"Thurman","year":"1994","journal-title":"Paraplegia"},{"key":"2020010102180061800_B4","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1093\/oxfordjournals.aje.a009262","article-title":"Evaluating sources of traumatic spinal cord injury surveillance data in Colorado","volume":"146","author":"Johnson","year":"1997","journal-title":"Am J Epidemiol"},{"key":"2020010102180061800_B5","unstructured":"National Spinal Cord Injury Statistical Center. Spinal cord injury facts and figures at a glance. Available at: https:\/\/www.nscisc.uab.edu\/public_content\/pdf\/Facts and Figures at a Glance 2010.pdf. Published February 2010. Accessed August 5, 2011."},{"key":"2020010102180061800_B6","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.pmr.2009.12.002","article-title":"Aging with spinal cord injury","volume":"21","author":"Charlifue","year":"2010","journal-title":"Phys Med Rehabil Clin N Am"},{"key":"2020010102180061800_B7","article-title":"Prevention of pressure sores through skin care","volume-title":"Spinal Cord Injury InfoSheets","author":"Lindsey","year":"2000"},{"key":"2020010102180061800_B8","doi-asserted-by":"crossref","first-page":"1848","DOI":"10.1016\/j.apmr.2004.03.017","article-title":"Aging with spinal cord injury: changes in selected health indices and life satisfaction","volume":"85","author":"Charlifue","year":"2004","journal-title":"Arch Phys Med Rehabil"},{"key":"2020010102180061800_B9","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1016\/S0003-9993(99)90251-4","article-title":"Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis","volume":"80","author":"McKinley","year":"1999","journal-title":"Arch Phys Med Rehabil"},{"key":"2020010102180061800_B10","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1097\/PHM.0b013e31817c16d6","article-title":"Secondary health complications in an aging Canadian spinal cord injury sample","volume":"87","author":"Hitzig","year":"2008","journal-title":"Am J Phys Med Rehabil"},{"key":"2020010102180061800_B11","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1080\/10790268.2008.11754570","article-title":"Predictors of pressure ulcer recurrence in veterans with spinal cord injury","volume":"31","author":"Guihan","year":"2008","journal-title":"J Spinal Cord Med"},{"key":"2020010102180061800_B12","first-page":"24","article-title":"Pressure ulcers prevalence, cost and risk assessment: consensus development conference statement","volume":"2","author":"The National Pressure Ulcer Advisory Panel","year":"1989","journal-title":"Decubitus"},{"key":"2020010102180061800_B13","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.amjsurg.2009.12.021","article-title":"High cost of stage IV pressure ulcers","volume":"200","author":"Brem","year":"2010","journal-title":"Am J Surg"},{"key":"2020010102180061800_B14","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1001\/jama.1992.03490060020004","article-title":"Recommendations seek to prevent pressure sores","volume":"268","author":"Marwick","year":"1992","journal-title":"JAMA"},{"key":"2020010102180061800_B15","first-page":"18","article-title":"Fourth national pressure ulcer prevalence survey","volume":"10","author":"Barczak","year":"1997","journal-title":"Adv Wound Care"},{"key":"2020010102180061800_B16","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1186\/1471-2458-9-168","article-title":"Staying physically active after spinal cord injury: a qualitative exploration of barriers and facilitators to exercise participation","volume":"9","author":"Kehn","year":"2009","journal-title":"BMC Public Health"},{"key":"2020010102180061800_B17","first-page":"B318","article-title":"Decubitus ulcers in spinal cord lesion: proactive inspection [in Dutch]","volume":"153","author":"Huijssen-Huisman","year":"2009","journal-title":"Ned Tijdschr Geneeskd"},{"key":"2020010102180061800_B18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1310\/sci1604-1","article-title":"Costs of care following spinal cord injury","volume":"16","author":"DeVivo","year":"2011","journal-title":"Top Spinal Cord Inj Rehabil"},{"key":"2020010102180061800_B19","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1310\/sci1604-62","article-title":"Cost of treating pressure ulcers for veterans with spinal cord injury","volume":"16","author":"Stroupe","year":"2011","journal-title":"Top Spinal Cord Inj Rehabil"},{"key":"2020010102180061800_B20","first-page":"22","article-title":"Pressure ulcers, hospital complications, and disease severity: impact on hospital costs and length of stay","volume":"12","author":"Allman","year":"1999","journal-title":"Adv Wound Care"},{"key":"2020010102180061800_B21","volume-title":"Treatment of Pressure Ulcers: Clinical Practice Guideline No. 15","author":"Bergstrom","year":"1994"},{"key":"2020010102180061800_B22","first-page":"307","volume-title":"Hydrotherapy and Pressure Ulcers in Comprehensive Aquatic Therapy","author":"Ho","year":"2004","edition":"2nd ed."},{"key":"2020010102180061800_B23","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1093\/ptj\/56.5.567","article-title":"Procedure for decontamination of hydrotherapy equipment","volume":"56","author":"McMillan","year":"1976","journal-title":"Phys Ther"},{"key":"2020010102180061800_B24","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1093\/ptj\/52.9.919","article-title":"Microbiological evaluation of decontamination procedures for hydrotherapy tanks","volume":"52","author":"Nelson","year":"1972","journal-title":"Phys Ther"},{"key":"2020010102180061800_B25","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/0305-4179(95)90787-Z","article-title":"Bilateral amputations following hydrotherapy tank burns in a paraplegic patient","volume":"21","author":"Hwang","year":"1995","journal-title":"Burns"},{"key":"2020010102180061800_B26","volume-title":"Hydrotherapy\/Therapeutic Pool Infection Control Guidelines","year":"1995"},{"key":"2020010102180061800_B27","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.3928\/0147-7447-19850801-13","article-title":"Pulsatile irrigation in orthopedics","volume":"8","author":"Sobel","year":"1985","journal-title":"Orthopedics"},{"key":"2020010102180061800_B28","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1097\/00002060-199809000-00006","article-title":"Effects of hydrotherapy on pressure ulcer healing","volume":"77","author":"Burke","year":"1998","journal-title":"Am J Phys Med Rehabil"},{"key":"2020010102180061800_B29","volume-title":"Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals","author":"Consortium for Spinal Cord Medicine, Paralyzed Veterans of America","year":"2000"},{"key":"2020010102180061800_B30","first-page":"48","article-title":"A prospective study evaluating the Pressure Ulcer Scale for Healing (PUSH Tool) to assess stage II, stage III, and stage IV pressure ulcers","volume":"55","author":"G\u00fcnes","year":"2009","journal-title":"Ostomy Wound Manage"},{"key":"2020010102180061800_B31","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1024\/1012-5302.20.4.225","article-title":"Valid and reliable methods for describing pressure sores and leg ulcer: a systematic literature review [in German]","volume":"20","author":"Panfil","year":"2007","journal-title":"Pflege"},{"key":"2020010102180061800_B32","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1097\/01.ASW.0000350839.19477.ce","article-title":"Wound areas by computerized planimetry of digital images: accuracy and reliability","volume":"22","author":"Mayrovitz","year":"2009","journal-title":"Adv Skin Wound Care"},{"key":"2020010102180061800_B33","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1016\/j.apmr.2006.06.014","article-title":"Reliability of electronic versus manual wound measurement techniques","volume":"87","author":"Haghpanah","year":"2006","journal-title":"Arch Phys Med Rehabil"},{"key":"2020010102180061800_B34","volume-title":"Applied Longitudinal Data Analysis","author":"Davidian","year":"2006"},{"key":"2020010102180061800_B35","doi-asserted-by":"crossref","DOI":"10.1007\/b97287","volume-title":"Statistical Methods for the Analysis of Repeated Measurements","author":"Davis","year":"2002"},{"key":"2020010102180061800_B36","volume-title":"Linear Mixed Models for Longitudinal Data","author":"Verbeke","year":"2000"},{"key":"2020010102180061800_B37","first-page":"2167","article-title":"Comparison of bulb syringe and pulsed lavage irrigation with use of a bioluminescent musculoskeletal wound model","volume":"88","author":"Svoboda","year":"2006","journal-title":"J Bone Joint Surg Am"},{"key":"2020010102180061800_B38","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1097\/00000658-197802000-00013","article-title":"Evaluation of wound irrigation by pulsatile jet and conventional methods","volume":"187","author":"Brown","year":"1978","journal-title":"Ann Surg"},{"key":"2020010102180061800_B39","first-page":"44","article-title":"The 105 bacterial growth guideline: reassessing its clinical relevance in wound healing","volume":"49","author":"Bowler","year":"2003","journal-title":"Ostomy Wound Manage"},{"key":"2020010102180061800_B40","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/01.blo.0000182246.37454.b2","article-title":"High-pressure pulsatile lavage propagates bacteria into soft tissue","volume":"439","author":"Hassinger","year":"2005","journal-title":"Clin Orthop Relat Res"},{"key":"2020010102180061800_B41","doi-asserted-by":"crossref","first-page":"241","DOI":"10.12968\/jowc.1998.7.5.241","article-title":"The role of physiotherapy in managing patients with wounds","volume":"7","author":"McCulloch","year":"1998","journal-title":"J Wound Care"},{"key":"2020010102180061800_B42","first-page":"44","article-title":"Pulsed lavage: promoting comfort and healing in home care","volume":"46","author":"Morgan","year":"2000","journal-title":"Ostomy Wound Manage"},{"key":"2020010102180061800_B43","volume-title":"Cost-Utility Analysis of Pulsatile Lavage Therapy in the Treatment of Stage II and IV Pressure Ulcers: Seminar Series","author":"Terris","year":"2003"},{"key":"2020010102180061800_B44","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1177\/193229681000400405","article-title":"Digital planimetry results in more accurate wound measurements: a comparison to standard ruler measurements","volume":"4","author":"Rogers","year":"2010","journal-title":"J Diabetes Sci Technol"},{"key":"2020010102180061800_B45","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1111\/j.1532-5415.1988.tb02385.x","article-title":"Pressure sore volume measurement: a technique to document and record wound healing","volume":"36","author":"Resch","year":"1988","journal-title":"J Am Geriatr Soc"},{"key":"2020010102180061800_B46","first-page":"29","article-title":"Analysis of the measurement of four wound variables in elderly patients with pressure ulcers","volume":"9","author":"Schubert","year":"1996","journal-title":"Adv Wound Care"},{"key":"2020010102180061800_B47","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1111\/j.1610-0387.2006.06113.x","article-title":"Three-dimensional documentation of wound healing: first results of a new objective method for measurement [in German]","volume":"4","author":"K\u00f6rber","year":"2006","journal-title":"J Dtsch Dermatol Ges"}],"container-title":["Physical Therapy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ptj\/article-pdf\/92\/1\/38\/31671118\/ptj0038.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ptj\/article-pdf\/92\/1\/38\/31671118\/ptj0038.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T08:38:36Z","timestamp":1638866316000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ptj\/article\/92\/1\/38\/2735126"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,1,1]]},"references-count":47,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2012,1,1]]}},"URL":"https:\/\/doi.org\/10.2522\/ptj.20100349","relation":{},"ISSN":["0031-9023","1538-6724"],"issn-type":[{"value":"0031-9023","type":"print"},{"value":"1538-6724","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,1,1]]}}}