Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Health and Rehabilitation Sciences


Houghton, Pamela E.


Pressure ulcers (PrU) are a secondary health complication that cause increased morbidity, mortality and decreased quality of life. PrUs have also been shown to have a significant financial burden on the healthcare system. Current best practice guidelines strongly recommend the use of Electrical Stimulation (E-Stim) to increase healing rates of PrUs. Unfortunately, there has been lack of uptake for the use of E-Stim in clinical practice. To address this gap in practice, a knowledge mobilization project called the E-Stim Collaboration Project was developed. The aim of this dissertation was to 1) determine if an education program can change knowledge, attitudes and practice (KAP) in a variety of health care providers providing care to people with PrUs, 2) the cost effectiveness of E-Stim, and 3) estimate the cost of PrU treatment in community dwelling individuals. Chapter 2 outlines an education program that was developed for health care providers (n=83) to determine whether KAP can be improved for the use of E-Stim in individuals with chronic wounds. Knowledge and attitudes were found to be significantly increased after the education program, certain attitudes changed after a hands-on workshop, however practice change only occurred in 39% of participants. Chapter 3 evaluates the cost effectiveness of E-Stim using decision analytic modelling to determine the cost per quality-adjusted life year (QALY). The model results showed that E-Stim is a cost-effective treatment for this patient population especially when compared to a more commonly used advanced wound therapy called negative pressure wound therapy. In Chapters 4 and 5, the cost of living in the community with a PrU is estimated from a health care and societal perspective using current PrU treatment methods and showed an average cost of $8247.48 per month which can be as high as $37,873.65 per month when a person develops osteomyelitis in the bone underlying their PrU. Health care costs spent to date on the 22 study participants who had their PrU for an average of 21.2 months was approximately $3,846,624.50. Using advanced wound therapies such as E-Stim are known to speed healing and avoid complications is warranted and cost effective.

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