Caitlin L. Hurd

Objective: Hospital-acquired pressure injuries (HAPIs) are adverse events that increase patients' pain, morbidity and length of stay. The aim of this study was to use an implementation science-informed approach to identify barriers and facilitators to HAPI prevention for adult inpatients from the perspective of different members of the healthcare team. Method: This interpretive description study used semi-structured interviews with healthcare assistants, managers, nurses, occupational therapists and wound care specialists in acute care hospitals across Alberta, Canada. A semi-structured interview guide queried perceptions of HAPI prevention practices, risk assessment, and perceived challenges and opportunities. Interviews were audio recorded, transcribed verbatim and independently coded by two researchers. Codes were deductively mapped to the Theoretical Domains Framework (TDF) and inductively themed; both deductive and inductive approaches were bridged into an overarching thematic conceptualisation by four researchers. Results: A total of 22 interviews, each lasting 30–60 minutes, were completed with staff from seven adult inpatient units. The themes and subthemes that emerged were: Patients (patient complexity, patient and family engagement); Staff (knowledge and skills, communication and collaboration); Resources (access and availability of equipment and devices; inappropriate use of products and resources); and Context (contextual differences, organisational culture). Most barriers were associated with the Environmental Context and Resources domain of the TDF. Conclusion: The identified barriers and facilitators to HAPI prevention in hospital spanned from patients to the organisational context more broadly, and may be applicable to diverse hospital settings. Further investigation should explore the causes of the barriers and facilitators to enable targeted implementation strategies to prevent the occurrence of HAPIs.

Aim: To explore pressure injury prevention and management in acute care settings from the perspective of patients, caregivers and families. Design: Cross‐sectional survey. Methods: A convenience sample of patients at risk of pressure injuries and their family or caregivers was recruited from medical, surgical and intensive care units across the province of Alberta, Canada. The custom survey included questions about perspectives on the care they received, involvement in care and preferences regarding involvement. Data were summarised with descriptive statistics and analysed using generalised estimating equations, logistic regressions and Mann–Whitney U ‐tests. Results: The response rate was 44%. The survey was completed by 161 participants (80.1% patients and 19.9% caregivers). The participants were 58.4% female, 63.4% from rural locations and 21.1% self‐reported a pressure injury. Participants were most involved in repositioning activities and least involved in activities related to exercise. While 80.7% of respondents reported knowing what a pressure injury was, 69.6% reported that they had not heard about or received prevention resources from the healthcare team. Hearing about pressure injury prevention while admitted to hospital was associated with a significantly lower self‐reported presence of pressure injuries. Brochures/pamphlets and verbal information were the most preferred educational resources. Conclusions: Patient and family perspectives should inform pressure injury education and prevention activities in acute care settings. We recommend utilising brochures/pamphlets and verbal information, enhancing activity levels and exercise, encouraging patients and families to actively participate in prevention and maintaining a culture of supporting patient and family advocacy. Implications for the Profession and/or Patient Care: Findings provide insight into patient and family perspectives on pressure injury prevention and management in the hospital setting that can be addressed to enhance patient and family‐centred pressure injury prevention. Patient or Public Contribution: Patient and family advisors informed the design of the survey and provided feedback on content, formatting and readability. Reporting Method: Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross‐sectional studies.

OBJECTIVE: To identify patient-centered approaches to pressure injury (PI) prevention and management for adults in acute care settings, including the strategies used and their effectiveness. DATA SOURCES: A comprehensive search strategy was developed using the JBI Participants, Concept, and Context framework. The authors searched EMBASE, CINAHL, MEDLINE, Scopus, Cochrane Library, ProQuest, the James Lind Alliance, Healthcare Excellence Canada, and PI-specific organizations for English-language publications from the past 10 years. STUDY SELECTION: The search identified 3055 articles, and 1422 duplicates were removed. Studies were excluded if they did not focus on patient-centered PI prevention and management, did not occur in acute care settings, or did not include data that could be extracted. Following abstract and full-text screening, 21 studies were included in this review. DATA EXTRACTION: Two independent reviewers extracted data on study design, interventions, and outcomes, and quality (using the Mixed Methods Appraisal Tool). DATA SYNTHESIS: The included studies reported 4 main PI prevention strategies: care bundles, educational interventions, technological interventions, or tools to assess or reduce PI risk. Quantitative findings consistently showed reduced PI incidence with patient-centered interventions. Qualitative studies emphasized the importance of knowledge, communication, and collaboration in enhancing patient involvement. Barriers to engagement included pain, cognitive impairment, and health care provider time constraints. The methodological quality of the included studies varied, with limitations due to a lack of blinding and incomplete outcome data. CONCLUSIONS: Patient-centered approaches can effectively reduce PI incidence in acute care. Future interventions should incorporate consistent education, tailored care plans, and effective communication to enhance patient engagement and improve PI prevention and management.

Background: Parental participation in their young children's rehabilitation has been promoted to increase intervention intensity, but parents' perspectives on increased involvement remain unclear. The objective of this study was to explore parents' experiences partnering with physical therapists (PTs) to administer early, intensive rehabilitation to their young children with cerebral palsy (CP).Methods: Twelve mothers and one father of children between 8 months and 3 years old with CP were interviewed. Semistructured interviews were conducted before and after parents partnered with a PT to deliver a 12 week activity‐based intervention targeting their child's lower extremities. The intervention occurred in the child's home and in PT clinical sites. Interviews were audio recorded and transcribed verbatim. Interpretive description was used as the methodological framework.Results: The three themes were (1) focus on maximizing the child's potential, (2) participation in intensive rehabilitation is challenging, and (3) the importance of a positive experience with therapy. Families discussed a number of barriers and facilitators to participating in intensive rehabilitation.Conclusions: These results provide considerations for clinicians and researchers to facilitate meaningful engagement of parents in their young children's rehabilitation. This is especially important with increasing evidence for early, activity‐based interventions for young children with CP.

Background: Perinatal stroke injures motor regions of the brain, compromising movement for life. Early, intensive, active interventions for the upper extremity are efficacious, but interventions for the lower extremity remain understudied. Objective: To determine the feasibility and potential efficacy of ELEVATE—Engaging the Lower Extremity Via Active Therapy Early—on gross motor function. Methods: We conducted a single-blind, two-arm, randomized controlled trial (RCT), with the Immediate Group receiving the intervention while the Delay Group served as a 3-month waitlist control. A separate cohort living beyond commuting distance was trained by their parents with guidance from physical therapists. Participants were 8 months to 3 years old, with MRI-confirmed perinatal ischemic stroke and early signs of hemiparesis. The intervention was play-based, focused on weight-bearing, balance and walking for 1 hour/day, 4 days/week for 12 weeks. The primary outcome was the Gross Motor Function Measure-66 (GMFM-66). Secondary outcomes included steps and gait analyses. Final follow-up occurred at age 4. Results: Thirty-four children participated (25 RCT, 9 Parent-trained). The improvement in GMFM-66 over 12 weeks was greater for the Immediate than the Delay Group in the RCT (average change 3.4 units higher) and greater in younger children. Average step counts reached 1370-3750 steps/session in the last week of training for all children. Parent-trained children also improved but with greater variability. Conclusions: Early, activity-intensive lower extremity therapy for young children with perinatal stroke is feasible and improves gross motor function in the short term. Longer term improvement may require additional bouts of intervention. Clinical trial registration: This study was registered at ClinicalTrials.gov (NCT01773369).

Background Perinatal stroke injures motor regions of the brain, compromising movement for life. Early, intensive, active interventions for the upper extremity are efficacious, but interventions for the lower extremity (LE) remain infrequent and understudied. Objective To determine the efficacy of ELEVATE – Engaging the Lower Extremity Via Active Therapy Early - on gross motor function, as compared to usual care. Method We conducted a single-blind, two-arm, randomized controlled trial (RCT), with the Immediate Group receiving the intervention while the Delay Group served as a three-month waitlist-control. A separate cohort living beyond commuting distance was trained by their parents with guidance from physical therapists. Participants were 8 months to 3 years old, with MRI-confirmed perinatal ischemic stroke and early signs of hemiparesis. The intervention was play-based, focused on weight-bearing, balance and walking for 1 hour/day, 4 days/week for 12 weeks. The primary outcome was the Gross Motor Function Measure-66 (GMFM-66). Secondary outcomes included steps and gait analyses. Final follow-up occurred at age four. Results Thirty-four children participated (25 RCT, 9 Parent-trained). The improvement in GMFM-66 over 12 weeks was greater for the Immediate than the Delay Group (average change 3.4 units higher) and greater in younger children. Average step counts reached 1370–3750 steps/session in the last week of training for all children. Parent-trained children also improved but with greater variability. Conclusions Early, activity-intensive LE therapy for young children with perinatal stroke is feasible and improves gross motor function in the short term. Longer term improvement may require additional bouts of intervention. Clinical trial registratio This study was registered at ClinicalTrials.gov (NCT01773369).