Process evaluation of daily electrical stimulation to prevent recurring pressure ulcers in individuals with spinal cord injury: the SCI PREVOLT trial

OBJECTIVE: This process evaluation assessed the implementation of electrical stimulation (ES) for pressure ulcers (PUs) prevention in individuals with spinal cord injury alongside a randomized controlled trial and identified facilitators and barriers for the implementation in home environment and rehabilitation care. METHOD: A mixed-methods evaluation was structured according to the RE-AIM framework. Semi-structured interviews were thematically analyzed using the Fleuren framework; questionnaire and fieldnote data were supplementary sources. RESULTS: rehabilitation centers was most effective; PUs prevention was the main motivation for participation. Participants reported both positive and negative effects of ES, although most perceived the intervention as beneficial overall. Adoption depended on prior experience, staff involvement, and motivation. Adherence was hindered by limited time, need for assistance, and user-friendliness. Barriers included limited evidence, unclear responsibilities, and lack of reimbursement. Successful maintenance requires flexibility, clear guidance, support, and additional training for professionals. CONCLUSION: ES is a promising but demanding intervention for PUs prevention. Limited evidence, usability issues, and organizational barriers hinder implementation. Improved usability, clear roles, and strong support are essential for future use.