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Factors Associated with Clinical Decisions and Pressure Ulcer Development in Long Term Care Residents

Allegretti, Ana Luiza Caltabiano (2008) Factors Associated with Clinical Decisions and Pressure Ulcer Development in Long Term Care Residents. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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With the growing number of elderly long-term care residents in the United States, pressure ulcers (PU) represent a significant healthcare problem. The National Pressure Ulcer Advisory Panel (NPUAP) reported in 2001 that the incidence rates of PU in long-term care residents ranged from 2.2% to 23.9% and the prevalence from 2.3% to 28%. Multiple risk factors for the development of PU have been suggested, and can be divided into extrinsic factors and intrinsic factors. The aims of this study were to: (1) conduct a focused literature review of intrinsic and extrinsic factors related to PU development in elderly long-term care residents; (2) conduct a secondary analysis of demographic and clinical data from Randomized Clinical Trial on Preventing Pressure Ulcers with Seat Cushions (RCT-SC), to identify risk factors associated with acquiring/not acquiring a PU in elderly long-term care residents. Three different methods were used to analyze the data: (a) stepwise logistic regression, (b) odds ratios, and (c) Exhaustive Chi-Square Automatic Interaction Detection (CHAID); and generate a decision-making tree for the prescription of wheelchairs and seat cushions by rehabilitation practitioners for elderly long-term care wheelchair users. Inter-rater and intra-rater reliability of the rehabilitation team decisions were also established. As a result of this study it was concluded that:(a) the focused literature review provided useful information about intrinsic, extrinsic and combinations of these risk factors in PU acquisition,(b) the stepwise logistic regression, odds ratios, and CHAID analyses confirmed known risk factors and added new risk factors that predict PU development,(c) the decision-making tree can be a starting point for rehabilitation practitioners that are new to the field of seating and mobility, and (d) the decision making tree showed that the use of a pressure mapping system is a good tool if used in combination with clinical judgment.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Allegretti, Ana Luiza Caltabianoala15@pitt.eduALA15
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairHolm, Margo B.mbholm@pitt.eduMBHOLM
Committee MemberBrienza, David M.dbrienza@pitt.eduDBRIENZA
Committee MemberRogers, Joan C.jcr@pitt.eduJCR
Committee MemberRosen, Julesrosenj@pitt.eduROSENJ
Committee MemberSchmeler, Mark R.schmeler@pitt.eduSCHMELER
Date: 8 September 2008
Date Type: Completion
Defense Date: 11 June 2008
Approval Date: 8 September 2008
Submission Date: 18 June 2008
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: clinical decision making; elderly; long term care; pressure ulcer; randomized clinical trial; seating and positioning
Other ID:, etd-06182008-153223
Date Deposited: 10 Nov 2011 19:48
Last Modified: 15 Nov 2016 13:44


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