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Nicky Cullum - One of the best experts on this subject based on the ideXlab platform.
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effectiveness of psychosocial interventions for the prevention and treatment of foot Ulcers in people with diabetes a systematic review
Diabetic Medicine, 2020Co-Authors: Gill Norman, Nicky Cullum, Maggie J Westby, Kavita Vedhara, Frances GameAbstract:Aim To identify and synthesize the evidence for the effectiveness of psychosocial interventions to promote the healing, and/or reduce the occurrence of, foot Ulceration in people with diabetes. Methods In March 2019 we searched CENTRAL, Medline, Embase and PsycInfo for randomized controlled trials of interventions with psychosocial components for people with diabetes. The primary outcomes of this review were foot Ulceration and healing. We assessed studies using the Cochrane risk-of-bias tool, the TIDieR checklist and GRADE. We conducted narrative synthesis and random-effects meta-analysis. Results We included 31 randomized controlled trials (4511 participants), of which most (24 randomized controlled trials, 4093 participants) were prevention studies. Most interventions were educational with a modest psychosocial component. Ulceration and healing were not reported in most studies; secondary outcomes varied. Evidence was of low or very low quality because of high risks of bias and imprecision, and few studies reported adherence or fidelity. In groups where participants had prior Ulceration, educational interventions had no clear effect on new Ulceration (low-quality evidence). Two treatment studies, assessing continuous pharmacist support and an intervention to promote understanding of well-being, reported healing but their evidence was also of very low quality. Conclusion Most psychosocial intervention randomized controlled trials assessing foot Ulcer outcomes in people with diabetes were prevention studies, and most interventions were primarily educational. Ulcer healing and development were not well reported. There is a need for better understanding of psychological and behavioural influences on Ulcer Incidence, healing and recurrence in people with diabetes. Randomized controlled trials of theoretically informed interventions, which assess clinical outcomes, are urgently required. (PROSPERO registration: CRD42016052960).
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skin status for predicting pressure Ulcer development a systematic review and meta analyses
International Journal of Nursing Studies, 2018Co-Authors: Chunhu Shi, Jo C Dumville, Nicky CullumAbstract:Abstract Background People with altered skin status are conventionally considered to have a higher risk of developing new Ulcers. However, the evidence underpinning this potentially prognostic relationship is unclear. Objectives To systematically review the evidence for the prognostic association of skin status with pressure Ulcer risk. Methods We performed a comprehensive electronic database search in February 2017 to identify longitudinal studies that considered skin status in multivariable analysis for predicting pressure Ulcer risk in any population. Study selection was conducted by two reviewers independently. We collected data on the characteristics of studies, participants, skin status, and results of multivariable analyses of skin status–pressure Ulcer Incidence associations. We applied the Quality In Prognosis Studies tool to assess risk of bias. We conducted meta-analyses using STATA where data were available from multivariable analyses. We used the Grades of Recommendation Assessment, Development and Evaluation approach to assess the certainty of evidence generated from each meta-analysis. Results We included 41 studies (with 162,299 participants, and 7382 having new Ulcers) that investigated 15 skin descriptors. Participants were predominantly hospitalised adults and long-term care residents (with a median age of 75.2 years). Studies had a median follow-up duration of 7.5 weeks. 61.0% (25/41) of studies were judged as being high risk of bias. 53.7% (22/41) of studies had small sample sizes. Subsequently, the certainty of evidence was rated as low or very low for all 13 meta-analyses that we conducted though all analyses showed statistically significant associations of specific skin descriptors–pressure Ulcer Incidence. People with non-blanchable erythema may have higher odds of developing pressure Ulcers than those without (Odds Ratio 3.08, 95% Confidence Interval 2.26–4.20 if pressure Ulcer preventive measures were not adjusted in multivariable analysis; 1.99, 1.76–2.25 if adjusted) (both low-certainty evidence). The evidence for other skin descriptors was judged as very low-certainty and their prognostic value is uncertain. Conclusions There is low-certainty evidence that people with non-blanchable erythema may be more likely to develop new pressure Ulcers than those without non-blanchable erythema. The evidence for the prognostic effects of other skin descriptors (e.g., history of pressure Ulcer) is of very low-certainty. The findings support regular skin assessment and preventive action being taken in the presence of non-blanchable erythema. Given the millions at risk of Ulceration and the widely recommended use of skin status as part of risk assessment there is a need for more, high quality confirmatory studies.
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support surfaces for pressure Ulcer prevention a network meta analysis
PLOS ONE, 2018Co-Authors: Jo C Dumville, Nicky CullumAbstract:Background Pressure Ulcers are a prevalent and global issue and support surfaces are widely used for preventing Ulceration. However, the diversity of available support surfaces and the lack of direct comparisons in RCTs make decision-making difficult. Objectives To determine, using network meta-analysis, the relative effects of different support surfaces in reducing pressure Ulcer Incidence and comfort and to rank these support surfaces in order of their effectiveness. Methods We conducted a systematic review, using a literature search up to November 2016, to identify randomised trials comparing support surfaces for pressure Ulcer prevention. Two reviewers independently performed study selection, risk of bias assessment and data extraction. We grouped the support surfaces according to their characteristics and formed evidence networks using these groups. We used network meta-analysis to estimate the relative effects and effectiveness ranking of the groups for the outcomes of pressure Ulcer Incidence and participant comfort. GRADE was used to assess the certainty of evidence. Main results We included 65 studies in the review. The network for assessing pressure Ulcer Incidence comprised evidence of low or very low certainty for most network contrasts. There was moderate-certainty evidence that powered active air surfaces and powered hybrid air surfaces probably reduce pressure Ulcer Incidence compared with standard hospital surfaces (risk ratios (RR) 0.42, 95% confidence intervals (CI) 0.29 to 0.63; 0.22, 0.07 to 0.66, respectively). The network for comfort suggested that powered active air-surfaces are probably slightly less comfortable than standard hospital mattresses (RR 0.80, 95% CI 0.69 to 0.94; moderate-certainty evidence). Conclusions This is the first network meta-analysis of the effects of support surfaces for pressure Ulcer prevention. Powered active air-surfaces probably reduce pressure Ulcer Incidence, but are probably less comfortable than standard hospital surfaces. Most prevention evidence was of low or very low certainty, and more research is required to reduce these uncertainties.
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preventing pressure Ulcers are pressure redistributing support surfaces effective a cochrane systematic review and meta analysis
International Journal of Nursing Studies, 2012Co-Authors: Elizabeth Mcinnes, Jo C Dumville, Asmara Jammaliblasi, Sally E M Bellsyer, Nicky CullumAbstract:Abstract Objectives To undertake a systematic review of the effectiveness of pressure redistributing support surfaces in the prevention of pressure Ulcers. Design Systematic review and meta-analysis. Data sources Cochrane Wound Group Specialised Register, The Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid EMBASE and EBSCO CINAHL. The reference sections of included trials were searched for further trials. Review methods Randomised controlled trials and quasi-randomised trials, published or unpublished, which assessed the effects of support surfaces in preventing pressure Ulcers (of any grade), in any patient group, in any setting compared to any other support surface, were sought. Two reviewers extracted and summarised details of eligible trials using a standardised form and assessed the methodological quality of each trial using the Cochrane risk of bias tool. Results Fifty-three eligible trials were identified with a total of 16,285 study participants. Overall the risk of bias in the included trials was high. Pooled analysis showed that: (i) foam alternatives to the standard hospital foam mattress reduce the Incidence of pressure Ulcers in people at risk (RR 0.40, 95% CI 0.21–0.74) and Australian standard medical sheepskins prevent pressure Ulcers compared to standard care (RR 0.48, 95% CI 0.31–0.74). Pressure-redistributing overlays on the operating table compared to standard care reduce postoperative pressure Ulcer Incidence (RR 0.53, 95% CI 0.33–0.85). Conclusions While there is good evidence that higher specification foam mattresses, sheepskins, and that some overlays in the operative setting are effective in preventing pressure Ulcers, there is insufficient evidence to draw conclusions on the value of seat cushions, limb protectors and various constant low pressure devices. The relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear. More robust trials are required to address these research gaps.
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support surfaces for pressure Ulcer prevention
Cochrane Database of Systematic Reviews . 2010;2010(5 ):artCD001735., 2010Co-Authors: Elizabeth Mcinnes, Jo C Dumville, Nicky Cullum, Sally E M Bellsyer, Asmara JammaliblasiAbstract:BACKGROUND: Pressure Ulcers (also known as bedsores, pressure sores, decubitus Ulcers) are areas of localised damage to the skin and underlying tissue due to pressure, shear or friction. They are common in the elderly and immobile and costly in financial and human terms. Pressure-relieving beds, mattresses and seat cushions are widely used as aids to prevention in both institutional and non-institutional settings. OBJECTIVES: This systematic review seeks to answer the following questions:(1) to what extent do pressure-relieving cushions, beds, mattress overlays and mattress replacements reduce the Incidence of pressure Ulcers compared with standard support surfaces?(2) how effective are different pressure-relieving surfaces in preventing pressure Ulcers, compared to one another? SEARCH STRATEGY: For this second update the Cochrane Wounds Group Specialised Register was searched (28/2/08), The Cochrane Central Register of Controlled Trials (CENTRAL)(2008 Issue 1), Ovid MEDLINE (1950 to February Week 3 2008), Ovid EMBASE (1980 to 2008 Week 08) and Ovid CINAHL (1982 to February Week 3 2008). The reference sections of included studies were searched for further trials. SELECTION CRITERIA: Randomised controlled trials (RCTs), published or unpublished, which assessed the effectiveness of beds, mattresses, mattress overlays, and seating cushions for the prevention of pressure Ulcers, in any patient group, in any setting. Study selection was undertaken by at least two authors independently with a third author resolving uncertainty. RCTs were eligible for inclusion if they reported an objective, clinical outcome measure such as Incidence and severity of new of pressure Ulcers developed. Studies which only reported proxy outcome measures such as interface pressure were excluded. DATA COLLECTION AND ANALYSIS: Trial data were extracted by one researcher and checked by a second. The results from each study are presented as relative risk for dichotomous variables. Where deemed appropriate, similar studies were pooled in a meta analysis. MAIN RESULTS: For this second update 11 trials met the inclusion criteria bringing the total number of RCTs included in the review to 52.Foam alternatives to the standard hospital foam mattress can reduce the Incidence of pressure Ulcers in people at risk. The relative merits of alternating and constant low pressure devices are unclear. There is one high quality trial comparing the different alternating pressure devices for pressure Ulcer prevention which suggests that alternating pressure mattresses may be more cost effective than alternating pressure overlays.Pressure-relieving overlays on the operating table have been shown to reduce postoperative pressure Ulcer Incidence, although two studies indicated that foam overlays resulted in adverse skin changes. Two trials indicated that Australian standard medical sheepskins prevented pressure Ulcers. There is insufficient evidence to draw conclusions on the value of seat cushions, limb protectors and various constant low pressure devices as pressure Ulcer prevention strategies.A study of Accident & Emergency trolley overlays did not identify a reduction in pressure Ulcer Incidence. There are tentative indications that foot waffle heel elevators, a particular low air loss hydrotherapy mattress and two types of operating theatre overlays are harmful. AUTHORS' CONCLUSIONS: In people at high risk of pressure Ulcer development higher specification foam mattresses rather than standard hospital foam mattresses should be used. The relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear but alternating pressure mattresses may be more cost effective than alternating pressure overlays. Medical grade sheepskins are associated with a decrease in pressure Ulcer development. Organisations might consider the use of some forms of pressure relief for high risk patients in the operating theatre. Seat cushions and overlays designed for use in Accident & Emergency settings have not been adequately evaluated.
David M. Brienza - One of the best experts on this subject based on the ideXlab platform.
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predictors of pressure Ulcer Incidence following traumatic spinal cord injury a secondary analysis of a prospective longitudinal study
Spinal Cord, 2018Co-Authors: David M. Brienza, Patricia Karg, Shilpa Krishnan, Gwendolyn Sowa, Ana Luiza Caltabiano AllegrettiAbstract:Secondary analysis of data from a prospective cohort study. The objective of this study was to identify the medical and demographic factors associated with the development of pressure Ulcers during acute-care hospitalization and inpatient rehabilitation following acute spinal cord injury. The study was carried out at acute hospitalization, inpatient rehabilitation and outpatient rehabilitation sites at a university medical center in the United States. Adults with acute traumatic spinal cord injury (n=104) were recruited within 24–72 h of admission to the hospital. Pressure Ulcer Incidence was recorded. Thirty-nine participants out of 104 (37.5%) developed at least one pressure Ulcer during acute-care hospitalization and inpatient rehabilitation. Univariate logistic regression analyses revealed significant association of pressure Ulcer Incidence for those with pneumonia and mechanical ventilation (P=0.01) and higher injury severity (ASIA A) (P=0.01). Multiple logistic regression showed that the odds of formation of a first pressure Ulcer in participants with ASIA A was 4.5 times greater than that for participants with ASIA B, CI (1–20.65), P=0.05, and 4.6 times greater than that for participants with ASIA C, CI (1.3–16.63), P=0.01. Among individuals with acute traumatic SCI, those with high-injury severity were at an increased risk to develop pressure Ulcers. Pneumonia was noted to be associated with the formation of pressure Ulcers.
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interface shear and pressure characteristics of wheelchair seat cushions
Journal of Rehabilitation Research and Development, 2011Co-Authors: Jonathan S Akins, Patricia Karg, David M. BrienzaAbstract:Pressure Ulcer Incidence rates have remained constant despite advances in support surface technology. Interface shear stress is recognized as a risk factor for pressure Ulcer development and is the focus of many shear reduction technologies incorporated into wheelchair cushions; however, shear reduction has not been quantified in the literature. We evaluated 21 commercial wheelchair seat cushions using a new methodology developed to quantify interface shear stress, interface pressure, and horizontal stiffness. Interface shear stress increased significantly with applied horizontal indenter displacement, while no significant difference was found for interface pressure. Material of construction resulted in significant differences in interface shear stress, interface pressure, and horizontal stiffness. This study shows that the existing International Organization for Standardization (ISO) 16840-2 horizontal stiffness measure provides similar information to the new horizontal stiffness measure. The lack of a relationship between interface shear stress and the overall horizontal stiffness measure, however, suggests that a pressure and shear force sensor should be used with the ISO 16840-2 horizontal stiffness measure to fully quantify a cushion's ability to reduce interface shear stress at the patient's bony prominences.
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a randomized clinical trial on preventing pressure Ulcers with wheelchair seat cushions
Journal of the American Geriatrics Society, 2010Co-Authors: David M. Brienza, Mary Jo Geyer, Sheryl F Kelsey, Patricia Karg, Anna Allegretti, Marian B Olson, Mark R Schmeler, Jeanne M Zanca, Marybeth Kusturiss, Margo B HolmAbstract: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.
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the relationship between pressure Ulcer Incidence and buttock seat cushion interface pressure in at risk elderly wheelchair users
Archives of Physical Medicine and Rehabilitation, 2001Co-Authors: David M. Brienza, Mary Jo Geyer, Sheryl F Kelsey, Patricia Karg, Elaine TreflerAbstract:Abstract Brienza DM, Karg PE, Geyer MJ, Kelsey S, Trefler E. The relationship between pressure Ulcer Incidence and buttock-seat cushion interface pressure in at-risk elderly wheelchair users. Arch Phys Med Rehabil 2001;82:529-33. Objective: To investigate the relation between pressure Ulcer Incidence and buttock-wheelchair seat cushion interface pressure measurements. Design: Secondary analysis of data from a randomized clinical trial. Setting: Skilled nursing facility. Patients: Thirty-two elderly patients (age, ≥ 65yr), with Braden score ≤ 18 and Braden mobility and activity subscale score ≤ 5, who used wheelchairs ≥ 6hr/d, were free of existing sitting-induced pressure Ulcers, and weighed ≤ 250lb. Interventions: Generic foam seat cushion or pressure-reducing seat cushion. Main Outcome Measures: The Incidence of sitting-induced pressure Ulcers over a 1- to 12-month period was compared with pressure measured between patients' buttocks and wheelchair seat cushions. A flexible pad with a 15 × 15 pressure sensor array was used to measure interface pressure. Results: Interface pressure measured on wheelchair seat cushions was higher ( p ≤.01 for both peak pressure and average of highest 4 pressures) for patients who developed sitting-acquired pressure Ulcers compared with those patients who did not. Conclusions: Results indicated that higher interface pressure measurements are associated with a higher Incidence of sitting-acquired pressure Ulcers for high-risk elderly people who use wheelchairs. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation
Elizabeth Mcinnes - One of the best experts on this subject based on the ideXlab platform.
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the effect of a patient centred care bundle intervention on pressure Ulcer Incidence intact a cluster randomised trial
International Journal of Nursing Studies, 2016Co-Authors: Wendy P. Chaboyer, Elizabeth Mcinnes, Merrilyn Banks, Shelley Roberts, Jennifer A. Whitty, Brigid M. Gillespie, Lukman Thalib, Tracey Bucknall, Joan Webster, Mandy TallottAbstract:Abstract Background Hospital-acquired pressure Ulcers are a serious patient safety concern, associated with poor patient outcomes and high healthcare costs. They are also viewed as an indicator of nursing care quality. Objective To evaluate the effectiveness of a pressure Ulcer prevention care bundle in preventing hospital-acquired pressure Ulcers among at risk patients. Design Pragmatic cluster randomised trial. Setting Eight tertiary referral hospitals with >200 beds each in three Australian states. Participants 1600 patients (200/hospital) were recruited. Patients were eligible if they were: ≥18 years old; at risk of pressure Ulcer because of limited mobility; expected to stay in hospital ≥48h and able to read English. Methods Hospitals (clusters) were stratified in two groups by recent pressure Ulcer rates and randomised within strata to either a pressure Ulcer prevention care bundle or standard care. The care bundle was theoretically and empirically based on patient participation and clinical practice guidelines. It was multi-component, with three messages for patients' participation in pressure Ulcer prevention care: keep moving; look after your skin; and eat a healthy diet. Training aids for patients included a DVD, brochure and poster. Nurses in intervention hospitals were trained in partnering with patients in their pressure Ulcer prevention care. The statistician, recruiters, and outcome assessors were blinded to group allocation and interventionists blinded to the study hypotheses, tested at both the cluster and patient level. The primary outcome, Incidence of hospital-acquired pressure Ulcers, which applied to both the cluster and individual participant level, was measured by daily skin inspection. Results Four clusters were randomised to each group and 799 patients per group analysed. The intraclass correlation coefficient was 0.035. After adjusting for clustering and pre-specified covariates (age, pressure Ulcer present at baseline, body mass index, reason for admission, residence and number of comorbidities on admission), the hazard ratio for new pressure Ulcers developed (pressure Ulcer prevention care bundle relative to standard care) was 0.58 (95% CI: 0.25, 1.33; p =0.198). No adverse events or harms were reported. Conclusions Although the pressure Ulcer prevention care bundle was associated with a large reduction in the hazard of Ulceration, there was a high degree of uncertainty around this estimate and the difference was not statistically significant. Possible explanations for this non-significant finding include that the pressure Ulcer prevention care bundle was effective but the sample size too small to detect this.
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support surfaces for pressure Ulcer prevention
Cochrane Database of Systematic Reviews, 2015Co-Authors: Elizabeth Mcinnes, Jo C Dumville, Asmara Jammaliblasi, Sally E M Bellsyer, Victoria Middleton, Nicola CullumAbstract:BACKGROUND: Pressure Ulcers (also known as bedsores, pressure sores, decubitus Ulcers) are areas of localised damage to the skin and underlying tissue due to pressure, shear or friction. They are common in the elderly and immobile and costly in financial and human terms. Pressure-relieving beds, mattresses and seat cushions are widely used as aids to prevention in both institutional and non-institutional settings. OBJECTIVES: This systematic review seeks to answer the following questions: to what extent do pressure-relieving cushions, beds, mattress overlays and mattress replacements reduce the Incidence of pressure Ulcers compared with standard support surfaces? how effective are different pressure-relieving surfaces in preventing pressure Ulcers, compared to one another? SEARCH STRATEGY: The Specialised Trials Register of the Cochrane Wounds Group (compiled from regular searches of many electronic databases including MEDLINE, CINAHL and EMBASE plus handsearching of specialist journals and conference proceedings) was searched up to January 2004, Issue 3, 2004 of the Cochrane Central Register of Controlled Trials was also searched. The reference sections of included studies were searched for further trials. SELECTION CRITERIA: Randomised controlled trials (RCTs), published or unpublished, which assessed the effectiveness of beds, mattresses, mattress overlays, and seating cushions for the prevention of pressure Ulcers, in any patient group, in any setting. RCTs were eligible for inclusion if they reported an objective, clinical outcome measure such as Incidence and severity of new of pressure Ulcers developed. Studies which only reported proxy outcome measures such as interface pressure were excluded. DATA COLLECTION AND ANALYSIS: Trial data were extracted by one researcher and checked by a second. The results from each study are presented as relative risk for dichotomous variables. Where deemed appropriate, similar studies were pooled in a meta analysis. MAIN RESULTS: 41 RCTs were included in the review. Foam alternatives to the standard hospital foam mattress can reduce the Incidence of pressure Ulcers in people at risk. The relative merits of alternating and constant low pressure devices, and of the different alternating pressure devices for pressure Ulcer prevention are unclear.Pressure-relieving overlays on the operating table have been shown to reduce postoperative pressure Ulcer Incidence, although one study indicated that an overlay resulted in adverse skin changes. One trial indicated that Australian standard medical sheepskins prevented pressure Ulcers. There is insufficient evidence to draw conclusions on the value of seat cushions, limb protectors and various constant low pressure devices as pressure Ulcer prevention strategies.A study of Accident & Emergency trolley overlays did not identify a reduction in pressure Ulcer Incidence. There are tentative indications that foot waffle heel elevators, a particular low air loss hydrotherapy mattress and an operating theatre overlay are harmful. REVIEWERS' CONCLUSIONS: In people at high risk of pressure Ulcer development, consideration should be given to the use of higher specification foam mattresses rather than standard hospital foam mattresses. The relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear. Organisations might consider the use of pressure relief for high risk patients in the operating theatre, as this is associated with a reduction in post-operative Incidence of pressure Ulcers. Seat cushions and overlays designed for use in Accident & Emergency settings have not been adequately evaluated.
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Repositioning for pressure Ulcer prevention in adults
Cochrane Database of Systematic Reviews, 2014Co-Authors: Brigid M. Gillespie, Elizabeth Mcinnes, Wendy P. Chaboyer, Bridie Kent, Jennifer A. Whitty, Lukman ThalibAbstract:BACKGROUND: A pressure Ulcer (PU), also referred to as a 'pressure injury', 'pressure sore', or 'bedsore' is defined as an area of localised tissue damage that is caused by unrelieved pressure, friction or shearing forces on any part of the body. PUs commonly occur in patients who are elderly and less mobile, and carry significant human and economic impacts. Immobility and physical inactivity are considered to be major risk factors for PU development and the manual repositioning of patients in hospital or long-term care is a common pressure Ulcer prevention strategy. OBJECTIVES: The objectives of this review were to:1) assess the effects of repositioning on the prevention of PUs in adults, regardless of risk or in-patient setting;2) ascertain the most effective repositioning schedules for preventing PUs in adults; and3) ascertain the incremental resource consequences and costs associated with implementing different repositioning regimens compared with alternate schedules or standard practice. SEARCH METHODS: We searched the following electronic databases to identify reports of the relevant randomised controlled trials: the Cochrane Wounds Group Specialised Register (searched 06 September 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 8); Ovid MEDLINE (1948 to August, Week 4, 2013); Ovid EMBASE (1974 to 2013, Week 35); EBESCO CINAHL (1982 to 30 August 2013); and the reference sections of studies that were included in the review. SELECTION CRITERIA: Randomised controlled trials (RCTs), published or unpublished, that assessed the effects of any repositioning schedule or different patient positions and measured PU Incidence in adults in any setting. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS: We included three RCTs and one economic study representing a total of 502 randomised participants from acute and long-term care settings. Two trials compared the 30º and 90º tilt positions using similar repositioning frequencies (there was a small difference in frequency of overnight repositioning in the 90º tilt groups between the trials). The third RCT compared alternative repositioning frequencies.All three studies reported the proportion of patients developing PU of any grade, stage or category. None of the trials reported on pain, or quality of life, and only one reported on cost. All three trials were at high risk of bias.The two trials of 30º tilt vs. 90º were pooled using a random effects model (I² = 69%) (252 participants). The risk ratio for developing a PU in the 30º tilt and the standard 90º position was very imprecise (pooled RR 0.62, 95% CI 0.10 to 3.97, P=0.62, very low quality evidence). This comparison is underpowered and at risk of a Type 2 error (only 21 events).In the third study, a cluster randomised trial, participants were randomised between 2-hourly and 3-hourly repositioning on standard hospital mattresses and 4 hourly and 6 hourly repositioning on viscoelastic foam mattresses. This study was also underpowered and at high risk of bias. The risk ratio for pressure Ulcers (any category) with 2-hourly repositioning compared with 3-hourly repositioning on a standard mattress was imprecise (RR 0.90, 95% CI 0.69 to 1.16, very low quality evidence). The risk ratio for pressure Ulcers (any category) was compatible with a large reduction and no difference between 4-hourly repositioning and 6-hourly repositioning on viscoelastic foam (RR 0.73, 95% CI 0.53 to 1.02, very low quality evidence).A cost-effectiveness analysis based on data derived from one of the included parallel RCTs compared 3-hourly repositioning using the 30º tilt overnight with standard care consisting of 6-hourly repositioning using the 90º lateral rotation overnight. In this evaluation the only included cost was nursing time. The intervention was reported to be cost saving compared with standard care (nurse time cost per patient €206.6 vs €253.1, incremental difference €-46.5; 95%CI: €-1.25 to €-74.60). AUTHORS' CONCLUSIONS: Repositioning is an integral component of pressure Ulcer prevention and treatment; it has a sound theoretical rationale, and is widely recommended and used in practice. The lack of robust evaluations of repositioning frequency and position for pressure Ulcer prevention mean that great uncertainty remains but it does not mean these interventions are ineffective since all comparisons are grossly underpowered. Current evidence is small in volume and at risk of bias and there is currently no strong evidence of a reduction in pressure Ulcers with the 30° tilt compared with the standard 90º position or good evidence of an effect of repositioning frequency. There is a clear need for high-quality, adequately-powered trials to assess the effects of position and optimal frequency of repositioning on pressure Ulcer Incidence.The limited data derived from one economic evaluation means it remains unclear whether repositioning every 3 hours using the 30º tilt is less costly in terms of nursing time and more effective than standard care involving repositioning every 6 hours using a 90º tilt.
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preventing pressure Ulcers are pressure redistributing support surfaces effective a cochrane systematic review and meta analysis
International Journal of Nursing Studies, 2012Co-Authors: Elizabeth Mcinnes, Jo C Dumville, Asmara Jammaliblasi, Sally E M Bellsyer, Nicky CullumAbstract:Abstract Objectives To undertake a systematic review of the effectiveness of pressure redistributing support surfaces in the prevention of pressure Ulcers. Design Systematic review and meta-analysis. Data sources Cochrane Wound Group Specialised Register, The Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid EMBASE and EBSCO CINAHL. The reference sections of included trials were searched for further trials. Review methods Randomised controlled trials and quasi-randomised trials, published or unpublished, which assessed the effects of support surfaces in preventing pressure Ulcers (of any grade), in any patient group, in any setting compared to any other support surface, were sought. Two reviewers extracted and summarised details of eligible trials using a standardised form and assessed the methodological quality of each trial using the Cochrane risk of bias tool. Results Fifty-three eligible trials were identified with a total of 16,285 study participants. Overall the risk of bias in the included trials was high. Pooled analysis showed that: (i) foam alternatives to the standard hospital foam mattress reduce the Incidence of pressure Ulcers in people at risk (RR 0.40, 95% CI 0.21–0.74) and Australian standard medical sheepskins prevent pressure Ulcers compared to standard care (RR 0.48, 95% CI 0.31–0.74). Pressure-redistributing overlays on the operating table compared to standard care reduce postoperative pressure Ulcer Incidence (RR 0.53, 95% CI 0.33–0.85). Conclusions While there is good evidence that higher specification foam mattresses, sheepskins, and that some overlays in the operative setting are effective in preventing pressure Ulcers, there is insufficient evidence to draw conclusions on the value of seat cushions, limb protectors and various constant low pressure devices. The relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear. More robust trials are required to address these research gaps.
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support surfaces for pressure Ulcer prevention
Cochrane Database of Systematic Reviews . 2010;2010(5 ):artCD001735., 2010Co-Authors: Elizabeth Mcinnes, Jo C Dumville, Nicky Cullum, Sally E M Bellsyer, Asmara JammaliblasiAbstract:BACKGROUND: Pressure Ulcers (also known as bedsores, pressure sores, decubitus Ulcers) are areas of localised damage to the skin and underlying tissue due to pressure, shear or friction. They are common in the elderly and immobile and costly in financial and human terms. Pressure-relieving beds, mattresses and seat cushions are widely used as aids to prevention in both institutional and non-institutional settings. OBJECTIVES: This systematic review seeks to answer the following questions:(1) to what extent do pressure-relieving cushions, beds, mattress overlays and mattress replacements reduce the Incidence of pressure Ulcers compared with standard support surfaces?(2) how effective are different pressure-relieving surfaces in preventing pressure Ulcers, compared to one another? SEARCH STRATEGY: For this second update the Cochrane Wounds Group Specialised Register was searched (28/2/08), The Cochrane Central Register of Controlled Trials (CENTRAL)(2008 Issue 1), Ovid MEDLINE (1950 to February Week 3 2008), Ovid EMBASE (1980 to 2008 Week 08) and Ovid CINAHL (1982 to February Week 3 2008). The reference sections of included studies were searched for further trials. SELECTION CRITERIA: Randomised controlled trials (RCTs), published or unpublished, which assessed the effectiveness of beds, mattresses, mattress overlays, and seating cushions for the prevention of pressure Ulcers, in any patient group, in any setting. Study selection was undertaken by at least two authors independently with a third author resolving uncertainty. RCTs were eligible for inclusion if they reported an objective, clinical outcome measure such as Incidence and severity of new of pressure Ulcers developed. Studies which only reported proxy outcome measures such as interface pressure were excluded. DATA COLLECTION AND ANALYSIS: Trial data were extracted by one researcher and checked by a second. The results from each study are presented as relative risk for dichotomous variables. Where deemed appropriate, similar studies were pooled in a meta analysis. MAIN RESULTS: For this second update 11 trials met the inclusion criteria bringing the total number of RCTs included in the review to 52.Foam alternatives to the standard hospital foam mattress can reduce the Incidence of pressure Ulcers in people at risk. The relative merits of alternating and constant low pressure devices are unclear. There is one high quality trial comparing the different alternating pressure devices for pressure Ulcer prevention which suggests that alternating pressure mattresses may be more cost effective than alternating pressure overlays.Pressure-relieving overlays on the operating table have been shown to reduce postoperative pressure Ulcer Incidence, although two studies indicated that foam overlays resulted in adverse skin changes. Two trials indicated that Australian standard medical sheepskins prevented pressure Ulcers. There is insufficient evidence to draw conclusions on the value of seat cushions, limb protectors and various constant low pressure devices as pressure Ulcer prevention strategies.A study of Accident & Emergency trolley overlays did not identify a reduction in pressure Ulcer Incidence. There are tentative indications that foot waffle heel elevators, a particular low air loss hydrotherapy mattress and two types of operating theatre overlays are harmful. AUTHORS' CONCLUSIONS: In people at high risk of pressure Ulcer development higher specification foam mattresses rather than standard hospital foam mattresses should be used. The relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear but alternating pressure mattresses may be more cost effective than alternating pressure overlays. Medical grade sheepskins are associated with a decrease in pressure Ulcer development. Organisations might consider the use of some forms of pressure relief for high risk patients in the operating theatre. Seat cushions and overlays designed for use in Accident & Emergency settings have not been adequately evaluated.
Jo C Dumville - One of the best experts on this subject based on the ideXlab platform.
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skin status for predicting pressure Ulcer development a systematic review and meta analyses
International Journal of Nursing Studies, 2018Co-Authors: Chunhu Shi, Jo C Dumville, Nicky CullumAbstract:Abstract Background People with altered skin status are conventionally considered to have a higher risk of developing new Ulcers. However, the evidence underpinning this potentially prognostic relationship is unclear. Objectives To systematically review the evidence for the prognostic association of skin status with pressure Ulcer risk. Methods We performed a comprehensive electronic database search in February 2017 to identify longitudinal studies that considered skin status in multivariable analysis for predicting pressure Ulcer risk in any population. Study selection was conducted by two reviewers independently. We collected data on the characteristics of studies, participants, skin status, and results of multivariable analyses of skin status–pressure Ulcer Incidence associations. We applied the Quality In Prognosis Studies tool to assess risk of bias. We conducted meta-analyses using STATA where data were available from multivariable analyses. We used the Grades of Recommendation Assessment, Development and Evaluation approach to assess the certainty of evidence generated from each meta-analysis. Results We included 41 studies (with 162,299 participants, and 7382 having new Ulcers) that investigated 15 skin descriptors. Participants were predominantly hospitalised adults and long-term care residents (with a median age of 75.2 years). Studies had a median follow-up duration of 7.5 weeks. 61.0% (25/41) of studies were judged as being high risk of bias. 53.7% (22/41) of studies had small sample sizes. Subsequently, the certainty of evidence was rated as low or very low for all 13 meta-analyses that we conducted though all analyses showed statistically significant associations of specific skin descriptors–pressure Ulcer Incidence. People with non-blanchable erythema may have higher odds of developing pressure Ulcers than those without (Odds Ratio 3.08, 95% Confidence Interval 2.26–4.20 if pressure Ulcer preventive measures were not adjusted in multivariable analysis; 1.99, 1.76–2.25 if adjusted) (both low-certainty evidence). The evidence for other skin descriptors was judged as very low-certainty and their prognostic value is uncertain. Conclusions There is low-certainty evidence that people with non-blanchable erythema may be more likely to develop new pressure Ulcers than those without non-blanchable erythema. The evidence for the prognostic effects of other skin descriptors (e.g., history of pressure Ulcer) is of very low-certainty. The findings support regular skin assessment and preventive action being taken in the presence of non-blanchable erythema. Given the millions at risk of Ulceration and the widely recommended use of skin status as part of risk assessment there is a need for more, high quality confirmatory studies.
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support surfaces for pressure Ulcer prevention a network meta analysis
PLOS ONE, 2018Co-Authors: Jo C Dumville, Nicky CullumAbstract:Background Pressure Ulcers are a prevalent and global issue and support surfaces are widely used for preventing Ulceration. However, the diversity of available support surfaces and the lack of direct comparisons in RCTs make decision-making difficult. Objectives To determine, using network meta-analysis, the relative effects of different support surfaces in reducing pressure Ulcer Incidence and comfort and to rank these support surfaces in order of their effectiveness. Methods We conducted a systematic review, using a literature search up to November 2016, to identify randomised trials comparing support surfaces for pressure Ulcer prevention. Two reviewers independently performed study selection, risk of bias assessment and data extraction. We grouped the support surfaces according to their characteristics and formed evidence networks using these groups. We used network meta-analysis to estimate the relative effects and effectiveness ranking of the groups for the outcomes of pressure Ulcer Incidence and participant comfort. GRADE was used to assess the certainty of evidence. Main results We included 65 studies in the review. The network for assessing pressure Ulcer Incidence comprised evidence of low or very low certainty for most network contrasts. There was moderate-certainty evidence that powered active air surfaces and powered hybrid air surfaces probably reduce pressure Ulcer Incidence compared with standard hospital surfaces (risk ratios (RR) 0.42, 95% confidence intervals (CI) 0.29 to 0.63; 0.22, 0.07 to 0.66, respectively). The network for comfort suggested that powered active air-surfaces are probably slightly less comfortable than standard hospital mattresses (RR 0.80, 95% CI 0.69 to 0.94; moderate-certainty evidence). Conclusions This is the first network meta-analysis of the effects of support surfaces for pressure Ulcer prevention. Powered active air-surfaces probably reduce pressure Ulcer Incidence, but are probably less comfortable than standard hospital surfaces. Most prevention evidence was of low or very low certainty, and more research is required to reduce these uncertainties.
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support surfaces for pressure Ulcer prevention
Cochrane Database of Systematic Reviews, 2015Co-Authors: Elizabeth Mcinnes, Jo C Dumville, Asmara Jammaliblasi, Sally E M Bellsyer, Victoria Middleton, Nicola CullumAbstract:BACKGROUND: Pressure Ulcers (also known as bedsores, pressure sores, decubitus Ulcers) are areas of localised damage to the skin and underlying tissue due to pressure, shear or friction. They are common in the elderly and immobile and costly in financial and human terms. Pressure-relieving beds, mattresses and seat cushions are widely used as aids to prevention in both institutional and non-institutional settings. OBJECTIVES: This systematic review seeks to answer the following questions: to what extent do pressure-relieving cushions, beds, mattress overlays and mattress replacements reduce the Incidence of pressure Ulcers compared with standard support surfaces? how effective are different pressure-relieving surfaces in preventing pressure Ulcers, compared to one another? SEARCH STRATEGY: The Specialised Trials Register of the Cochrane Wounds Group (compiled from regular searches of many electronic databases including MEDLINE, CINAHL and EMBASE plus handsearching of specialist journals and conference proceedings) was searched up to January 2004, Issue 3, 2004 of the Cochrane Central Register of Controlled Trials was also searched. The reference sections of included studies were searched for further trials. SELECTION CRITERIA: Randomised controlled trials (RCTs), published or unpublished, which assessed the effectiveness of beds, mattresses, mattress overlays, and seating cushions for the prevention of pressure Ulcers, in any patient group, in any setting. RCTs were eligible for inclusion if they reported an objective, clinical outcome measure such as Incidence and severity of new of pressure Ulcers developed. Studies which only reported proxy outcome measures such as interface pressure were excluded. DATA COLLECTION AND ANALYSIS: Trial data were extracted by one researcher and checked by a second. The results from each study are presented as relative risk for dichotomous variables. Where deemed appropriate, similar studies were pooled in a meta analysis. MAIN RESULTS: 41 RCTs were included in the review. Foam alternatives to the standard hospital foam mattress can reduce the Incidence of pressure Ulcers in people at risk. The relative merits of alternating and constant low pressure devices, and of the different alternating pressure devices for pressure Ulcer prevention are unclear.Pressure-relieving overlays on the operating table have been shown to reduce postoperative pressure Ulcer Incidence, although one study indicated that an overlay resulted in adverse skin changes. One trial indicated that Australian standard medical sheepskins prevented pressure Ulcers. There is insufficient evidence to draw conclusions on the value of seat cushions, limb protectors and various constant low pressure devices as pressure Ulcer prevention strategies.A study of Accident & Emergency trolley overlays did not identify a reduction in pressure Ulcer Incidence. There are tentative indications that foot waffle heel elevators, a particular low air loss hydrotherapy mattress and an operating theatre overlay are harmful. REVIEWERS' CONCLUSIONS: In people at high risk of pressure Ulcer development, consideration should be given to the use of higher specification foam mattresses rather than standard hospital foam mattresses. The relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear. Organisations might consider the use of pressure relief for high risk patients in the operating theatre, as this is associated with a reduction in post-operative Incidence of pressure Ulcers. Seat cushions and overlays designed for use in Accident & Emergency settings have not been adequately evaluated.
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preventing pressure Ulcers are pressure redistributing support surfaces effective a cochrane systematic review and meta analysis
International Journal of Nursing Studies, 2012Co-Authors: Elizabeth Mcinnes, Jo C Dumville, Asmara Jammaliblasi, Sally E M Bellsyer, Nicky CullumAbstract:Abstract Objectives To undertake a systematic review of the effectiveness of pressure redistributing support surfaces in the prevention of pressure Ulcers. Design Systematic review and meta-analysis. Data sources Cochrane Wound Group Specialised Register, The Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid EMBASE and EBSCO CINAHL. The reference sections of included trials were searched for further trials. Review methods Randomised controlled trials and quasi-randomised trials, published or unpublished, which assessed the effects of support surfaces in preventing pressure Ulcers (of any grade), in any patient group, in any setting compared to any other support surface, were sought. Two reviewers extracted and summarised details of eligible trials using a standardised form and assessed the methodological quality of each trial using the Cochrane risk of bias tool. Results Fifty-three eligible trials were identified with a total of 16,285 study participants. Overall the risk of bias in the included trials was high. Pooled analysis showed that: (i) foam alternatives to the standard hospital foam mattress reduce the Incidence of pressure Ulcers in people at risk (RR 0.40, 95% CI 0.21–0.74) and Australian standard medical sheepskins prevent pressure Ulcers compared to standard care (RR 0.48, 95% CI 0.31–0.74). Pressure-redistributing overlays on the operating table compared to standard care reduce postoperative pressure Ulcer Incidence (RR 0.53, 95% CI 0.33–0.85). Conclusions While there is good evidence that higher specification foam mattresses, sheepskins, and that some overlays in the operative setting are effective in preventing pressure Ulcers, there is insufficient evidence to draw conclusions on the value of seat cushions, limb protectors and various constant low pressure devices. The relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear. More robust trials are required to address these research gaps.
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support surfaces for pressure Ulcer prevention
Cochrane Database of Systematic Reviews . 2010;2010(5 ):artCD001735., 2010Co-Authors: Elizabeth Mcinnes, Jo C Dumville, Nicky Cullum, Sally E M Bellsyer, Asmara JammaliblasiAbstract:BACKGROUND: Pressure Ulcers (also known as bedsores, pressure sores, decubitus Ulcers) are areas of localised damage to the skin and underlying tissue due to pressure, shear or friction. They are common in the elderly and immobile and costly in financial and human terms. Pressure-relieving beds, mattresses and seat cushions are widely used as aids to prevention in both institutional and non-institutional settings. OBJECTIVES: This systematic review seeks to answer the following questions:(1) to what extent do pressure-relieving cushions, beds, mattress overlays and mattress replacements reduce the Incidence of pressure Ulcers compared with standard support surfaces?(2) how effective are different pressure-relieving surfaces in preventing pressure Ulcers, compared to one another? SEARCH STRATEGY: For this second update the Cochrane Wounds Group Specialised Register was searched (28/2/08), The Cochrane Central Register of Controlled Trials (CENTRAL)(2008 Issue 1), Ovid MEDLINE (1950 to February Week 3 2008), Ovid EMBASE (1980 to 2008 Week 08) and Ovid CINAHL (1982 to February Week 3 2008). The reference sections of included studies were searched for further trials. SELECTION CRITERIA: Randomised controlled trials (RCTs), published or unpublished, which assessed the effectiveness of beds, mattresses, mattress overlays, and seating cushions for the prevention of pressure Ulcers, in any patient group, in any setting. Study selection was undertaken by at least two authors independently with a third author resolving uncertainty. RCTs were eligible for inclusion if they reported an objective, clinical outcome measure such as Incidence and severity of new of pressure Ulcers developed. Studies which only reported proxy outcome measures such as interface pressure were excluded. DATA COLLECTION AND ANALYSIS: Trial data were extracted by one researcher and checked by a second. The results from each study are presented as relative risk for dichotomous variables. Where deemed appropriate, similar studies were pooled in a meta analysis. MAIN RESULTS: For this second update 11 trials met the inclusion criteria bringing the total number of RCTs included in the review to 52.Foam alternatives to the standard hospital foam mattress can reduce the Incidence of pressure Ulcers in people at risk. The relative merits of alternating and constant low pressure devices are unclear. There is one high quality trial comparing the different alternating pressure devices for pressure Ulcer prevention which suggests that alternating pressure mattresses may be more cost effective than alternating pressure overlays.Pressure-relieving overlays on the operating table have been shown to reduce postoperative pressure Ulcer Incidence, although two studies indicated that foam overlays resulted in adverse skin changes. Two trials indicated that Australian standard medical sheepskins prevented pressure Ulcers. There is insufficient evidence to draw conclusions on the value of seat cushions, limb protectors and various constant low pressure devices as pressure Ulcer prevention strategies.A study of Accident & Emergency trolley overlays did not identify a reduction in pressure Ulcer Incidence. There are tentative indications that foot waffle heel elevators, a particular low air loss hydrotherapy mattress and two types of operating theatre overlays are harmful. AUTHORS' CONCLUSIONS: In people at high risk of pressure Ulcer development higher specification foam mattresses rather than standard hospital foam mattresses should be used. The relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear but alternating pressure mattresses may be more cost effective than alternating pressure overlays. Medical grade sheepskins are associated with a decrease in pressure Ulcer development. Organisations might consider the use of some forms of pressure relief for high risk patients in the operating theatre. Seat cushions and overlays designed for use in Accident & Emergency settings have not been adequately evaluated.
Patricia Karg - One of the best experts on this subject based on the ideXlab platform.
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predictors of pressure Ulcer Incidence following traumatic spinal cord injury a secondary analysis of a prospective longitudinal study
Spinal Cord, 2018Co-Authors: David M. Brienza, Patricia Karg, Shilpa Krishnan, Gwendolyn Sowa, Ana Luiza Caltabiano AllegrettiAbstract:Secondary analysis of data from a prospective cohort study. The objective of this study was to identify the medical and demographic factors associated with the development of pressure Ulcers during acute-care hospitalization and inpatient rehabilitation following acute spinal cord injury. The study was carried out at acute hospitalization, inpatient rehabilitation and outpatient rehabilitation sites at a university medical center in the United States. Adults with acute traumatic spinal cord injury (n=104) were recruited within 24–72 h of admission to the hospital. Pressure Ulcer Incidence was recorded. Thirty-nine participants out of 104 (37.5%) developed at least one pressure Ulcer during acute-care hospitalization and inpatient rehabilitation. Univariate logistic regression analyses revealed significant association of pressure Ulcer Incidence for those with pneumonia and mechanical ventilation (P=0.01) and higher injury severity (ASIA A) (P=0.01). Multiple logistic regression showed that the odds of formation of a first pressure Ulcer in participants with ASIA A was 4.5 times greater than that for participants with ASIA B, CI (1–20.65), P=0.05, and 4.6 times greater than that for participants with ASIA C, CI (1.3–16.63), P=0.01. Among individuals with acute traumatic SCI, those with high-injury severity were at an increased risk to develop pressure Ulcers. Pneumonia was noted to be associated with the formation of pressure Ulcers.
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interface shear and pressure characteristics of wheelchair seat cushions
Journal of Rehabilitation Research and Development, 2011Co-Authors: Jonathan S Akins, Patricia Karg, David M. BrienzaAbstract:Pressure Ulcer Incidence rates have remained constant despite advances in support surface technology. Interface shear stress is recognized as a risk factor for pressure Ulcer development and is the focus of many shear reduction technologies incorporated into wheelchair cushions; however, shear reduction has not been quantified in the literature. We evaluated 21 commercial wheelchair seat cushions using a new methodology developed to quantify interface shear stress, interface pressure, and horizontal stiffness. Interface shear stress increased significantly with applied horizontal indenter displacement, while no significant difference was found for interface pressure. Material of construction resulted in significant differences in interface shear stress, interface pressure, and horizontal stiffness. This study shows that the existing International Organization for Standardization (ISO) 16840-2 horizontal stiffness measure provides similar information to the new horizontal stiffness measure. The lack of a relationship between interface shear stress and the overall horizontal stiffness measure, however, suggests that a pressure and shear force sensor should be used with the ISO 16840-2 horizontal stiffness measure to fully quantify a cushion's ability to reduce interface shear stress at the patient's bony prominences.
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a randomized clinical trial on preventing pressure Ulcers with wheelchair seat cushions
Journal of the American Geriatrics Society, 2010Co-Authors: David M. Brienza, Mary Jo Geyer, Sheryl F Kelsey, Patricia Karg, Anna Allegretti, Marian B Olson, Mark R Schmeler, Jeanne M Zanca, Marybeth Kusturiss, Margo B HolmAbstract: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.
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the relationship between pressure Ulcer Incidence and buttock seat cushion interface pressure in at risk elderly wheelchair users
Archives of Physical Medicine and Rehabilitation, 2001Co-Authors: David M. Brienza, Mary Jo Geyer, Sheryl F Kelsey, Patricia Karg, Elaine TreflerAbstract:Abstract Brienza DM, Karg PE, Geyer MJ, Kelsey S, Trefler E. The relationship between pressure Ulcer Incidence and buttock-seat cushion interface pressure in at-risk elderly wheelchair users. Arch Phys Med Rehabil 2001;82:529-33. Objective: To investigate the relation between pressure Ulcer Incidence and buttock-wheelchair seat cushion interface pressure measurements. Design: Secondary analysis of data from a randomized clinical trial. Setting: Skilled nursing facility. Patients: Thirty-two elderly patients (age, ≥ 65yr), with Braden score ≤ 18 and Braden mobility and activity subscale score ≤ 5, who used wheelchairs ≥ 6hr/d, were free of existing sitting-induced pressure Ulcers, and weighed ≤ 250lb. Interventions: Generic foam seat cushion or pressure-reducing seat cushion. Main Outcome Measures: The Incidence of sitting-induced pressure Ulcers over a 1- to 12-month period was compared with pressure measured between patients' buttocks and wheelchair seat cushions. A flexible pad with a 15 × 15 pressure sensor array was used to measure interface pressure. Results: Interface pressure measured on wheelchair seat cushions was higher ( p ≤.01 for both peak pressure and average of highest 4 pressures) for patients who developed sitting-acquired pressure Ulcers compared with those patients who did not. Conclusions: Results indicated that higher interface pressure measurements are associated with a higher Incidence of sitting-acquired pressure Ulcers for high-risk elderly people who use wheelchairs. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation
