title: Positioning bedridden patients to reduce interface pressures over the sacrum and great trochanter.
abstract: OBJECTIVE
  In this study, we evaluated the effect of hip-joint rotation on the interface pressure over the sacrum and greater trochanter with a new protocol for positioning of bedridden elderly patients.
  
  
  METHODS
  The interface pressure values over the sacrum and greater trochanter in bedridden patients were evaluated. These were collected in the supine position, 90° lateral position, and 30° and 40° laterally inclined positions with external rotation or neutral positioning of the hip joint. Each interface pressure was assessed with a device measuring pressure distribution, after which, the peak pressure index (PPI) was calculated.
  
  
  RESULTS
  In the 17 patients examined, the PPI over the sacrum in the supine position was significantly greater than that in other positions. In the 30° and 40° laterally inclined positions, the PPIs over the greater trochanter were significantly lower in the neutral position of the hip joint compared with those in the external rotation position.
  
  
  CONCLUSIONS
  Our findings revealed the effects of hip-joint rotation on the interface pressure for the greater trochanter, possibly due to the increased distance between the greater trochanter and the sacrum caused by neutral position of the hip joint. The results demonstrate that it is to best place the hip joint in a neutral position when the legs are in contact with the bed in order to distribute the pressure over the greater trochanter in the 30° and 40° laterally inclined positions. These results can be applied to the clinical setting to improve patient positioning and decrease pressure ulcers.
  
  
  BACKGROUND
  The authors declare that they have no competing financial interests.
authors.affiliation: Miyabinosato Home-Visit nursing care Station, Akashi, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Yoshikawa
authors.affiliation: Kobe University Graduate School of Health Sciences, Kobe, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Maeshige
authors.affiliation: Faculty of Rehabilitation, Kobegakuin University, Kobe, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Sugimoto
authors.affiliation: Kobe University Graduate School of Health Sciences, Kobe, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Uemura
authors.affiliation: Department of Nursing, Kobe University Hospital, Kobe, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Noguchi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Terashi
mesh_terms: D000369:Aged, 80 and over; D001512:Bedding and Linens; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D056888:Patient Positioning; D003668:Pressure Ulcer / Q000517:prevention & control*; D012399:Rotation; D012447:Sacrum / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
keywords: 30° laterally inclined position; hip rotation; interface pressure distribution; positioning; pressure ulcer; pressure ulcer prevention