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Pressure ulcers: a scourge for all but particularly for those living in low- and middle-income countries

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A notable paper by van Middendorp et al.1 mapped the top 10 research priorities in the area of spinal cord injuries for Britain. It captured the perspectives of a multitude of people including those with spinal cord injury. This paper perhaps gained inspiration from one of the first papers in the area of spinal cord injuries to try and determine the research priorities of people with spinal cord injury.2 This study was conducted in the United States and is widely cited particularly by those conducting research in the prioritised areas.

These and other similar papers are interesting and useful studies. However, I wonder what the research priorities would be of all people across the globe that live with spinal cord injuries. What if we could capture the research priorities of people living in low- and middle-income countries including those experiencing life-threatening complications secondary to spinal cord injury? If we could capture their opinions, then short of curing paralysis, I would like to guess that their research priorities would be to identify strategies for the treatment and prevention of pressure ulcers.

Pressure ulcers are a leading cause of mortality and suffering for a large number of people with spinal cord injury worldwide and particularly for those living in low- and middle-income countries. Yet, we do not have accurate population-based incidence data to verify this claim. This might be a good first research step to ensure that this topic receives the research attention it deserves. A paper in this edition by Groves et al.3 provides some initial data about the scope of the problem of pressure ulcers in those who sustained spinal cord injuries following the 2015 earthquakes in Nepal. Zakrasek et al.4 also summarised some of the literature around this issue. Both these papers highlight the problems of pressure ulcers in low- and middle-income countries, and provide useful data. Spinal Cord also regularly publishes papers on different aspects of pressure ulcer management—albeit largely from researchers in high-income countries where the problems and solutions are perhaps different to low- and middle-income countries.

Spinal Cord is in a unique position for a journal to encourage and tackle the problems of pressure ulcers in low- and middle-income countries. Its privileged position stems from its truly international focus. This in turn reflects the nature and mission of the journal’s owner: the International Spinal Cord Society. Spinal Cord will continue to publish and prioritise papers that tackle global issues for those living with spinal cord injuries. Better solutions for the treatment and prevention of pressure ulcers in low- and middle-income countries are high on the list of research priorities for a journal interested in having a global impact.

References

  1. 1

    van Middendorp JJ, Allison HC, Ahuja S, Bracher D, Dyson C, Fairbank J et al. Top ten research priorities for spinal cord injury: the methodology and results of a British priority setting partnership. Spinal Cord 2016; 54: 341–346.

  2. 2

    Anderson KD . Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma 2004; 21: 1371–1383.

  3. 3

    Groves CC, Poudel MK, Baniya M, Rana C, House DR . Descriptive study of earthquake-related spinal cord injury in Nepal. Spinal Cord 2017; 55:705–710.

  4. 4

    Zakrasek EC, Creasey G, Crew JD . Pressure ulcers in people with spinal cord injury in developing nations. Spinal Cord 2015; 53: 7–13.

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Correspondence to L A Harvey.

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