A randomized clinical trial on preventing pressure ulcers with wheelchair seat cushions.
OBJECTIVE
To determine the efficacy of skin protection wheelchair seat cushions in preventing pressure ulcers in the elderly nursing home population.


METHODS
Clinical trial with participants assigned at random to a skin protection or segmented foam cushion. Two hundred thirty-two participants were recruited between June 2004 and May 2008 and followed for 6 months or until pressure ulcer incidence.


METHODS
Twelve nursing homes.


METHODS
Nursing home residents aged 65 and older who were using wheelchairs for 6 or more hours per day and had a Braden score of 18 or less and a combined Braden activity and mobility score of 5 or less. Participants were recruited from a referred sample.


METHODS
All participants were provided with a fitted wheelchair and randomized into skin protection (SPC, n=113) or segmented foam (SFC, n=119) cushion groups. The SPC group received an air, viscous fluid and foam, or gel and foam cushion. The SFC group received a 7.6-cm crosscut foam cushion.


METHODS
Pressure ulcer incidence over 6 months for wounds near the ischial tuberosities (IT ulcers) were measured. Secondary analysis was performed on combined IT ulcers and ulcers over the sacrum and coccyx (sacral ulcers).


RESULTS
One hundred eighty participants reached a study end point, and 42 were lost to follow-up. Ten did not receive the intervention. There were eight (6.7%) IT ulcers in the SFC group and one (0.9%) in the SPC group (P=.04). There were 21 (17.6%) combined IT and sacral ulcers in the SFC group and 12 (10.6%) in the SPC group (P=.14).


CONCLUSIONS
Skin protection cushions used with fitted wheelchairs lower pressure ulcer incidence for elderly nursing home residents and should be used to help prevent pressure ulcers.
Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania 15206, USA. dbrienza@pitt.edu
David
D
Brienza
Sheryl
S
Kelsey
Patricia
P
Karg
Ana
A
Allegretti
Marian
M
Olson
Mark
M
Schmeler
Jeanne
J
Zanca
Mary Jo
MJ
Geyer
Marybeth
M
Kusturiss
Margo
M
Holm
D000368:Aged; D000369:Aged, 80 and over; D006804:Ergonomics; D005260:Female; D016330:Frail Elderly; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D009989:Orthotic Devices; D017060:Patient Satisfaction; D010414:Pennsylvania / Q000453:epidemiology; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control*; D017592:Skin Care / Q000379:methods*; D014910:Wheelchairs