Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Health and Rehabilitation Sciences


Houghton, Pamela E

2nd Supervisor

Wolfe, Dalton L



Pressure injuries are a common secondary health complication among individuals with a spinal cord injury (SCI) and can have a profound effect on quality of life. Unfortunately, pressure injury care in community dwelling individuals with SCI is often fragmented and inconsistent across Canada. Current best practice guidelines strongly recommend the use of electrical stimulation therapy (EST) to manage pressure injury in this population; however, there is little uptake of EST, and is not considered as a first-line treatment by many clinicians. Therefore, the objective of this dissertation is two-folds 1) to determine the impact of pressure injuries on individuals with SCI (Chapter 2), and 2) to utilize a systematic approach to implementing EST for managing pressure injuries in community dwelling individuals with SCI living in South West Local Health Integrated Network (LHIN) in Ontario (Chapters 3, 4, and 5). The first study highlighted the importance of implementing pressure injury prevention and management programs in this high-risk population by reporting the negative effect that pressure injuries has on the ability of individuals with SCI to participate in activities of daily living and recreational activities, and the significant impact on quality of life and health care utilization. In studies 2 and 3, a pressure injury model of care involving EST was developed based on the barriers and facilitators identified by local stakeholders. The model was later adapted to fit the local environment by a team of local experts and a SCI consumer in a two-day workshop. The final study used iterative plan, do, study, act (PDSA) cycles to implement the adapted model of care into current practices. Multiple issues associated with key implementation activities were identified to limit the sustainability of EST for treating pressure injuries in community dwelling individuals with SCI, despite the numerous strategies put in place to solve the issues. However, these studies not only provide a clear approach to implementing pressure injury best practices, but the findings provide important insight to future researchers or clinicians interested in implementing EST for managing pressure injuries in community dwelling individuals with SCI.