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

Brienza, David M.; Kelsey, Sheryl F.; Karg, Patricia; Allegretti, Ana; Olson, Marian B.; Schmeler, Mark R.; Zanca, Jeanne M.; Geyer, Mary Jo; Kusturiss, MaryBeth; Holm, Margo B.

doi:10.1111/j.1532-5415.2010.03168.x

Cited by 90 publications

(64 citation statements)

References 17 publications

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“…Employing more therapists with seating expertise increases institutional costs; however, the potential reduction in inappropriate wheelchair prescription is likely to counterbalance this additional expenditure. For example, a recent randomized controlled trial demonstrated a significant reduction in sitting-acquired pressure ulcers in nursing home residents when a properly fitted wheelchair and cushion were provided by a seating specialist [24] . The 22% prevalence rate in two Vancouver nursing homes reported by Bourbonniere et al [14] is well below those observed in this study.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Facility Level Correlates of Need for Wheelchair Seating Assessment among Long-Term Care Residents

2012

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Background: Wheelchairs are frequently prescribed for residents with mobility impairments in long-term care. Many residents receive poorly fitting wheelchairs, compromising functional independence and mobility, and contributing to subsequent health issues such as pressure ulcers. The extent of this problem and the factors that predict poor fit are poorly understood; such evidence would contribute greatly to effective and efficient clinical practice in long-term care. Objective: To identify the prevalence of need for wheelchair seating intervention among residents in long-term care facilities in Vancouver and explore the relationship between the need for seating intervention and facility level factors. Methods: Logistic regression analysis using secondary data from a cross-sectional study exploring predictors of resident mobility. A total of 263 residents (183 females and 80 males) were randomly selected from 11 long-term care facilities in the Vancouver health region (mean age 84.2 ± 8.6 years). The Seating Identification Tool was used to establish subject need for wheelchair seating intervention. Individual item frequency was calculated. Six contextual variables were measured at each facility including occupational therapy staffing, funding source, policies regarding wheelchair-related equipment, and decision-making philosophy. Results: The overall prevalence rate of inappropriate seating was 58.6% (95% CI 52.6–64.5), ranging from 30.4 to 81.8% among the individual facilities. Discomfort, poor positioning and mobility, and skin integrity were the most common issues. Two facility level variables were significant predictors of need for seating assessment: ratio of occupational therapists per 100 residents [OR 0.11 (CI 0.04, 0.31)] and expectation that residents purchase wheelchair equipment beyond the basic level [OR 2.78 (1.11, 6.97)]. A negative association between facility prevalence rate and ratio of occupational therapists (r_p = –0.684, CI –0.143 to –0.910) was found. Conclusion: Prevalence of need for seating assessment in long-term care is high overall but it varies considerably between facilities. Increasing access to occupational therapy services appears to mediate this need.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Facility Level Correlates of Need for Wheelchair Seating Assessment among Long-Term Care Residents

2012

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“…Returning to the wheelchair cushion example: the occupationbased therapist not only considers a wheelchair cushion for its effectiveness in preventing the formation of decubitus ulcers but also for its ability to support clients comfortably and safely while allowing them to engage in their occupations. Presently, the majority of the literature on wheelchair cushions provides evidence regarding pressure-sore prevention or wound care (e.g., Brienza et al, 2010). This is insufficient; to advance occupation-based practice, research on wheelchair cushions must examine outcomes not only in relation to decubitus ulcers but also to occupational engagement, in safety and with comfort.…”

mentioning

confidence: 99%

Advancing occupation-based practice: Interpreting the rhetoric

Polatajko¹,

Davis²

2012

Can J Occup Ther

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“…Este resultado se aproximou de duas pesquisas com pacientes acamados no domicílio que demonstraram este perfil etário, com médias de idade de 86,7 anos (± 7,6) (BRIENZA et al, 2010), e 77,6 (± 11,3) (MORAES et al, 2012). Segundo Chayamiti e Caliri (2010) a idade avançada é apontada como um dos mais relevantes fatores envolvidos na fisiopatogênese da UPP.…”

Section: Discussõesunclassified

“…Brienza et al (2010) têm referido que a resistência em pacientes com baixa mobilidade e imersão inadequada nas superfícies almofadas e colchões pode conduzir a uma pressão de indução de isquemia prolongada e de cisalhamento que se acredita ser o fator primário que conduz ao desenvolvimento de UPP.…”

Section: Discussõesunclassified

“…Tanto a mudança de decúbito, quanto a proteção das proeminências ósseas estão descritas na literatura como intervenções necessárias para a prevenção de UPP em pessoas acamadas (BRIENZA et al, 2010). Apesar dos cuidadores terem recebido orientações de como controlar o excesso de pressão nas proeminências ósseas dos acamados investigados, este tipo de cuidado não recebeu a devida importância, em razão da baixa adesão (25%) na proteção dessas proeminências.…”

Section: Discussõesunclassified

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Cuidados de enfermagem na prevenção de úlcera por pressão em pacientes acamados no domicílio

Ayala¹,

Galende²,

Stoeberl³

2017

Semin. Cienc. Biol. Saude

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Este estudo foi desenvolvido na área de abrangência de uma Unidade Básica de Saúde em Joinville/SC com pacientes acamados no domicílio. Teve como objetivos, caracterizar o risco dos acamados para o desenvolvimento de úlcera por pressão; descrever os fatores propícios para o seu surgimento e avaliar a adesão aos cuidados prescritos na prevenção desta lesão. Trata-se de um estudo descritivo e exploratório. A coleta de dados foi realizada por meio de instrumento contendo dados de identificação, condições clínicas dos pacientes e pela aplicação da escala de Braden. Foram avaliados 12 pacientes acamados. A média de idade dos pacientes avaliados foi de 80,5 anos. A maioria era branca, com baixa escolaridade e dependente dos serviços públicos de saúde. Todos os pacientes possuíam alguma doença de base, sendo a mais frequente o Acidente Vascular Cerebral. O tempo de acamado foi de 67 meses (± 53). A mobilidade e a percepção sensorial estavam completamente ou muito limitadas, em 83% e 50% dos avaliados, respectivamente. 67% dos usuários apresentavam o estado nutricional muito pobre ou inadequado e 92% a pele constantemente úmida ou muito úmida. A baixa ingesta hídrica esteve presente para todos os participantes. A adesão dos cuidadores aos cuidados prescritos foi parcial. Ao final do estudo constatou-se que os achados estão em consonância com os dados da literatura e que os pacientes investigados possuíam um risco elevado para o desenvolvimento de úlcera por pressão, uma vez que os fatores propícios ao aparecimento da lesão se mostravam com frequências elevadas. Palavras chave: Úlcera por pressão. Assistência domiciliar. Fatores de risco não é um descritor da saúde do DECS/. OBS: a palavra chave fatores de risco aparece na biblioteca virtual em saúde como um descritor em ciências da saúde.This study was carried out in the catchment area of a Basic Health Unit in Joinville/SC bedridden patients receiving home care. We aimed to characterize the risk of the bedridden to develop pressure ulcers, describing the factors favorable to its emergence, and evaluate adherence to treatment prescribed to prevent this injury. This is a descriptive study. Data collection was carried out through an instrument containing identification data, clinical conditions of patients and the application of the Braden scale. Twelve bedridden patients were evaluated. The average age of the patients evaluated was 80.5 years. Most were white, with low education and dependent on public health services. All patients had some underlying disease, the most frequent the Stroke (CVA). The laid up time was 67 months (± 53). The mobility and sensory perception were completely or limited in 83% and 50% of the patients evaluated, respectively. Sixty-seven percent of users had very poor nutritional status or inadequate and 92% were constantly moist or very moisty. Low fluid intake was present for all participants. Adherence to prescribed care of the caregivers was partial. The findings at the end of the study are consistent with the literature and the studied patie...

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

Cited by 90 publications

References 17 publications

Prevalence and Facility Level Correlates of Need for Wheelchair Seating Assessment among Long-Term Care Residents

Prevalence and Facility Level Correlates of Need for Wheelchair Seating Assessment among Long-Term Care Residents

Advancing occupation-based practice: Interpreting the rhetoric

Cuidados de enfermagem na prevenção de úlcera por pressão em pacientes acamados no domicílio

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