A randomized control trial to evaluate pressure-reducing seat cushions for elderly wheelchair users.
OBJECTIVE
To determine if the use of pressure-reducing wheelchair cushions for elderly nursing home resident wheelchair users who are at high risk for developing sitting-acquired pressure ulcers would result in a lower incidence rate of pressure ulcers, a greater number of days until ulceration, and lower peak interface pressures compared with the use of convoluted foam cushions over a 12-month period. To determine the feasibility of conducting a subsequent full-scale definitive trial to evaluate the use of pressure-reducing seat cushions for elderly nursing home resident wheelchair users.


METHODS
Randomized control trial


METHODS
2200-bed skilled nursing facilities (1 suburban and 1 urban academic medical center)


METHODS
32 male and female at-risk nursing home residents who were wheelchair users > or = 65 years of age. Participants had Braden Scale scores < or = 18, Braden Activity and Mobilitysubscale scores < or = 5, no sitting surface pressure ulcers, and a daily wheelchair sitting tolerance of more than 6 hours. All met criteria for using the ETAC Twin wheelchair.


METHODS
Seating evaluation with pressure-mapping and subsequent seating prescription. Subjects were assigned to either a foam (n=17) or pressure-reducing cushion (n=15) group and weekly assessments of skin and pressure ulcer risk were made.


METHODS
Incidence of pressure ulcers, days to ulceration, and peak interface pressure.


RESULTS
At a 95% confidence interval, a 2-tailed analysis showed no differences between the FOAM and pressure-reducing cushion groups for pressure ulcer incidence, total days to pressure ulcer, or initial peak interface pressure. Pressure-reducing cushions were more effective in preventing sitting-acquired (ischial) pressure ulcers (P<.005). Higher interface pressures were associated with a higher incidence of pressure ulcers (P<.001).


CONCLUSIONS
A definitive randomized control multicenter cushion trial is feasible with a sample size of 50 to 100 per study group. In the definitive trial, the definition of sitting-acquired pressure ulcers should be limited to lesions occurring over the ischial tuberosities.
Geyer
M J
MJ
University of Pittsburgh, Department of Rehabilitation Science and Technology, PA, USA.
Brienza
D M
DM
Karg
P
P
Trefler
E
E
Kelsey
S
S
D000368:Aged; D006804:Ergonomics; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes; D011312:Pressure; D003668:Pressure Ulcer / Q000517:prevention & control*; D012307:Risk Factors; D016896:Treatment Outcome; D014910:Wheelchairs