Volume 58, Issue 12 p. 2308-2314

A Randomized Clinical Trial on Preventing Pressure Ulcers with Wheelchair Seat Cushions

David Brienza PhD

David Brienza PhD

From the Departments of Rehabilitation Science and Technology

Bioengineering

McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

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Sheryl Kelsey PhD

Sheryl Kelsey PhD

Epidemiology

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Patricia Karg MS

Patricia Karg MS

From the Departments of Rehabilitation Science and Technology

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Ana Allegretti PhD

Ana Allegretti PhD

From the Departments of Rehabilitation Science and Technology

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Marian Olson MS

Marian Olson MS

Epidemiology

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Mark Schmeler PhD

Mark Schmeler PhD

From the Departments of Rehabilitation Science and Technology

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Jeanne Zanca PhD

Jeanne Zanca PhD

Department of Rehabilitation Medicine Mount Sinai School of Medicine, New York, New York.

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Mary Jo Geyer PhD

Mary Jo Geyer PhD

From the Departments of Rehabilitation Science and Technology

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Marybeth Kusturiss MS

Marybeth Kusturiss MS

Physical Medicine and Rehabilitation

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Margo Holm PhD

Margo Holm PhD

Occupational Therapy

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First published: 10 November 2010
Citations: 76
Address correspondence to David Brienza, University of Pittsburgh, 6425 Penn Ave, Suite 401, Pittsburgh, PA 15206. E-mail: [email protected]

Abstract

OBJECTIVES: To determine the efficacy of skin protection wheelchair seat cushions in preventing pressure ulcers in the elderly nursing home population.

DESIGN: 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.

SETTING: Twelve nursing homes.

PARTICIPANTS: 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.

INTERVENTION: 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.

MEASUREMENTS: 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).

CONCLUSION: 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.