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 either 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’ age ≥ 65, using wheelchairs ≥6 hours/day, Braden score ≤ 18, and combined Braden activity and mobility score ≤ 5. Participants were recruited from a referred sample.
Intervention
All participants were provided a fitted wheelchair and randomized into skin protection (SPC) or segmented foam (SFC) cushion groups. The SPC group received an air, viscous fluid/foam, or gel/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 and sacral/coccyx ulcers.
Results
One hundred eighty participants reached a study endpoint and 42 were lost to follow-up. Ten did not receive the intervention. There were 8/119 (6.7%) IT ulcers in the SFC group and 1/113 (0.9%) in the SPC group (p<0.04). In the group of combined IT and sacral/coccyx ulcers, there were 21/119 pressure ulcers (17.6%) in the SFC group and 12/113 (10.6%) in the SPC group (p=0.14).
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.
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.
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.
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