Secondary Health Complications

Secondary health complications, such as pressure ulcers, pain and inappropriate bladder management negatively impact the health of a person living with a spinal cord injury.

ONF funds and supports several projects around secondary health complications with the goal of improving quality of life for people with SCI.

ONF funded projects

A few major activities that ONF has supported in this area include:

Canadian Best Practice Guidelines for Pressure Ulcers

Pressure sores are the most common secondary health complication of SCI. Sitting over 16 hours a day in a wheelchair often leads to pressure sores, a complication that traditionally was prescribed bed rest. But for many with SCI, bed rest is not successful. Too often it leads to further complications, infections, hospitalization, even life threatening conditions. It compromises activities of daily living, disrupts employment, education and family life, as well as increasing the burden on the caregiver.

ONF, in partnership with the Rick Hansen Institute (RHI), responded to the need to develop a more effective approach to prevent and manage pressure ulcers by supporting research to create standardized, evidence-based practices for the treatment of pressure sores.

Working with those living with SCI, as well as wound care and SCI experts, this partnership was able to implement the best practices for treating pressure sores. These guidelines are now current and applicable within the Canadian healthcare context. To view these guidelines, please see SCI Pressure Ulcers Best Practice Guidelines (PDF 25.7 MB).

ONF in partnership with Spinal Cord Injury Ontario developed a parallel set of guidelines for people living with SCI and their caregivers: Preventing and Treating Pressure Sores: A Guide for People with Spinal Cord Injuries.

ONF is now partnering with RHI and the Alberta Parapelegic Foundation in taking the lead for implementing these best practices in Ontario, Quebec, Alberta, and ultimately across Canada.

Neuropathic Pain Practice Guideline development

Chronic pain, is a common secondary health condition for people with SCI. Almost 40 percent of individuals with SCI have chronic and/or neuropathic pain. Recognizing the critical need for guidelines in this area, a team led by Dr. Eldon Loh from Parkwood Hospital in London, Ontario have taken the lead to develop the guidelines for management of neuropathic pain. These guidelines will assist in standardization of care and appropriate management of pain for individuals with SCI. Effective pain management is important to improve psychosocial, as well as physical health and overall quality of life for people with SCI.

The guidelines are now available at:

The guidelines are the focus of a November summit that will bring together pain specialists from the acute, rehabilitation and community sectors to consider the most effective approaches to move the newly-published guidelines into clinical practice. Patient leaders as well as those with an interest in health policy will be providing input to the discussions.

Spinal Cord Injury Knowledge Mobilization Network (SCI KMN)

ONF, along with six rehabilitation centres, established the Spinal Cord Injury Knowledge Mobilization Network (SCI KMN) with a shared goal of implementing best practices in the care and treatment of secondary complications due to spinal cord injury. For more information about this project, click here.


AusCAN is an international partnership on the topic if sitting-acquired pressure ulcers between investigators in Australia and Canada. The project is funded by ONF and the Rick Hansen Institute in Canada, and the National Health and Medical Research Council in Australia.

The project has been underway in Australia and Canada since 2012 and is being led by Jillian Swaine and Professor Michael Stacey in Australia, and Dr. Keith Hayes, Dr. Karen Campbell and Dr. Cathy Craven in Canada.

This is an international prospective study of the risk factors for pressure injuries sustained by individuals who have acquired spinal cord injury. Part 1 is a prospective study that will identify risk factors associated with the development of a sitting acquired pressure ulcer (SAPU) or suspected deep tissue injury in acute and chronic cohorts with SCI. Part 2 will assess individuals who develop a SAPU or suspected deep tissue injury to measure the loss of health related quality of life and to quantify the costs of treating their SAPU or suspected deep tissue injury.

Subjects are being recruited from 10 sites – 4 state spinal cord injury units in Australia (Western Australia, New South Wales, Victoria, South Australia) and 3 major SCI centres in Canada (London, Toronto and Quebec City) and it is intended that about 150 subjects will complete the study. 50 participants will be acute (new SCI) and 100 will be chronic (more than 10 years post SCI).

There are currently 105 participants enrolled in the study at various stages of study completion. Plans are to continue following participants until the end of 2017. At that time the full statistical analyses will be conducted and the new risk assessment tool developed.


To date there have been a number of publications, conference presentations and training videos developed as a result of the work around this extensive study.

Stacey, M.C., Swaine, J.M., Edwards, J., Rahmatzadeh, M., Wallace,H. Genetic polymorphisms may influence the development and healing of sitting-acquired pressure ulcers following spinal cord injury. Topics in Spinal Cord Rehabilitation. 2012;18(2):132-134.

Swaine, J., Nguyen, V., Romeo, M., & Van Wollingen, B. (2011). The impact of integrating interface pressure mapping into structured pressure care self-management. Australian Occupational Therapy Journal, 58(Supplement 1), 36.

Swaine, J., Stacey, MC, Hayes, K., Nguyen, V., (2011). AusCAN Risk Assessment for Sitting Acquired Pressure Ulcers. Australian Occupational Therapy Journal, 58(Supplement 1), 35.

Swaine, J., Mason, R., Stacey, MC (2011). Does Ultrasound Screening of the Pelvis Have a Role in the Wheelchair Seating Assessment? A Pilot Study. Australian Occupational Therapy Journal, 58(Supplement 1), 35.

Swaine, J., Stacey, M., Van Wollingen, B., Romeo, M., Nguyen, V., Khan, M. Interface pressure measurements at the buttocks-seat interface in healthy individuals and individuals with a spinal cord injury. A gauge repeatability, reproducibility and process evaluation study for a new research protocol (in preparation). Archives of Physical Medical Rehabilitation.

Swaine, J., Mason, R., Bader, D.L., Oomens, C. (2012) Buttocks soft tissue response to loaded sitting – an in vivo clinical test of tissue creep. (submitted). Journal of Tissue Viability.

Romeo, M, Swaine, J., Nguyen, V. & Stacey, M. (in preparation). The reliability of post processing parameters for interface pressure mapping. Journal of Tissue Viability.

Swaine, J., Khan, M., Stacey, MC. (in preparation). Ultrasonic detection of deep tissue injury overlying the ischium following spinal cord injury. Spinal Cord