OBJECTIVE: To compare a multi-component motivational interviewing (MI)/self-management (SM) intervention to a multi-component education intervention to improve skin-protective behaviors and prevent skin worsening in veterans with spinal cord injury (SCI) hospitalized for severe pressure ulcers. DESIGN: Single blinded, prospective, randomized controlled trial SETTING: 6 VA SCI Centers. PARTICIPANTS: Veterans admitted for a severe (stage III/IV) pressure ulcer (PrU) at were followed up to 6 months post-discharge. INTERVENTION: Telephone-based individual MI counseling plus SM skills group (MI+SM, n = 71) versus an active control group of telephone-based individual educational counseling plus a group education (ED, n = 72). MAIN OUTCOME MEASURES: Self-reported skin protective behaviors, objective skin worsening RESULTS: ITT analyses found non-significant increases in skin behaviors in the SM+MI versus ED arms at 3 and 6 months. The difference in behaviors used between SM+MI versus ED participants was 4.6% (95% CI -11.3 to 2.7) (0 to 3 months) and 3.0% (95% CI -8.7 to 3.9) (0 to 6 months). High rates of skin worsening were observed (n = 74, 51.7%), usually within 3 months post-discharge, most frequently within the month post-discharge. Skin worsening, skin-related visits and re-admissions did not differ by study arm. Study limitations are presented. CONCLUSION: For persons with chronic SCI and severe PrUs, complicated by multiple comorbidities, a primary focus on improving patient behavior is likely insufficient to address the complex problem of PrUs in SCI. More health care systems-level changes such as collaborative care may be needed to reduce PrU recurrence, especially in this era in which many people are discharged from the hospital unhealed or with little sitting tolerance.

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