title: The effect of a trunk release maneuver on Peak Pressure Index, trunk displacement and perceived discomfort in older adults seated in a High Fowler's position: a randomized controlled trial.
abstract: BACKGROUND
  Pressure ulcers pose significant negative individual consequences and financial burden on the healthcare system. Prolonged sitting in High Fowler's position (HF) is common clinical practice for older adults who spend extended periods of time in bed. While HF aids in digestion and respiration, being placed in a HF may increase perceived discomfort and risk of pressure ulcers due to increased pressure magnitude at the sacral and gluteal regions. It is likely that shearing forces could also contribute to risk of pressure ulcers in HF. The purpose of this study was to evaluate the effect of a low-tech and time-efficient Trunk Release Manuever (TRM) on sacral and gluteal pressure, trunk displacement and perceived discomfort in ambulatory older adults.
  
  
  METHODS
  A randomized controlled trial was used. We recruited community-living adults who were 60 years of age and older using posters, newspaper advertisements and word-of-mouth. Participants were randomly allocated to either the intervention or control group. The intervention group (n = 59) received the TRM, while the control group (n = 58) maintained the standard HF position.
  
  
  RESULTS
  The TRM group had significantly lower mean (SD) PPI values post-intervention compared to the control group, 59.6 (30.7) mmHg and 79.9 (36.5) mmHg respectively (p = 0.002). There was also a significant difference in trunk displacement between the TRM and control groups, +3.2 mm and -5.8 mm respectively (p = 0.005). There were no significant differences in perceived discomfort between the groups.
  
  
  CONCLUSIONS
  The TRM was effective for reducing pressure in the sacral and gluteal regions and for releasing the trunk at the point of contact between the skin and the support surface, but did not have an effect on perceived discomfort. The TRM is a simple method of repositioning which may have important clinical application for the prevention of pressure ulcers that may occur as a result of HF.
authors.affiliation: Rehabilitation Sciences Graduate Program, University of British Columbia, T325 - 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada.
authors.forename: Krista L
authors.initials: KL
authors.lastname: Best
authors.forename: Guylaine
authors.initials: G
authors.lastname: Desharnais
authors.forename: Jeanette
authors.initials: J
authors.lastname: Boily
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.forename: Pat G
authors.initials: PG
authors.lastname: Camp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D058748:Pain Perception / Q000502:physiology*; D026741:Physical Therapy Modalities; D011187:Posture / Q000502:physiology*; D011312:Pressure; D016037:Single-Blind Method; D060726:Torso / Q000502:physiology*; D016896:Treatment Outcome