CLINICAL PRACTICE GUIDELINE Future Research A comprehensive review of the research literature on the prevention and treatment of pressure ulcers after SCI was completed in 1998 and again in 2013 (in order to update changes in the field). To the extent possible, the recommendations in this clinical practice guideline were based on the findings reported in these reviews. Improvements in prevention and treatment require future research. Potential research questions include the following: What is the risk threshold that should determine recommendation of a specific type of pressure redistribution support surface for a person with SCI? Can a universally accepted validated measure of pressure ulcer risk be developed and validated for a spinal cord injury? What are the biomarkers of pressure ulcer formation? Can noninvasive imaging techniques be developed and validated for early pressure ulcer detection? What are biomarkers of pressure ulcer healing? What is the effectiveness of the use of negative pressure wound therapy or skin substitutes as treatments for pressure ulcers in persons with SCI? What is the effectiveness of the use of stem cells, tissue derived growth factors, or platelet-rich plasma as treatments for pressure ulcers? Which dressing is the most effective for a particular category/stage and condition of a wound? What is the most effective means for teaching pressure ulcer prevention and treatment? What is the optimal pathway for conservative management of a pressure ulcer? What is the optimal pathway for surgical management of a pressure ulcer? What types of outpatient programs are effective in reducing pressure ulcer recurrence among persons with spinal cord injury? 67