ABSTRACT
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.
DESIGN: Randomized control trial
SETTING: 2 200-bed skilled nursing facilities (1 suburban and 1 urban academic medical center)
PATIENTS: 32 male and female at-risk nursing home residents who were wheelchair users >=65 years of age. Participants had Braden Scale scores <=18, Braden Activity and Mobility subscale scores <=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.
INTERVENTIONS: 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.
MAIN OUTCOME MEASURES: Incidence of pressure ulcers, days to ulceration, and peak interface pressure.
MAIN 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.
PURPOSE: To offer an educational experience that will help to improve the participant's understanding of how pressure-reducing wheelchair cushions for elderly nursing home residents were evaluated in a randomized control trial.
TARGET AUDIENCE: This CME/CE activity is intended for physicians and nurses with an interest in the management of elderly wheelchair users who are at high risk for developing sitting-acquired pressure ulcers.
LEARNING OBJECTIVES: At the conclusion of this course, participants should be able to:
1. Identify the risk for development of sitting-acquired pressure ulcers among elderly nursing home wheelchair users.
2. Describe the use of the Braden Scale in identifying those nursing home residents at high risk for pressure ulcer development.
3. Summarize the issues related to seat cushion research and sitting-acquired pressure ulcers among elderly wheelchair users.