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Damiao J, Gentry T. A systematic review of the effectiveness of pressure relieving cushions in reducing pressure injury. Assist Technol 2024; 36:373-377. [PMID: 34813723 DOI: 10.1080/10400435.2021.2010148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 10/19/2022] Open
Abstract
This systematic review seeks to gather and analyze the evidence on wheelchair pressure relieving cushions, and report on the optimal materials and designs for reducing pressure injury risk. The following research question guides this study: Which wheelchair cushions best reduce pressure injury risk? PIs continue to impact the health and function of wheelchairs users with significant mobility impairments. Pressure relieving cushions are typically prescribed to provide pressure relief in the pre-wound, wound, and post-wound phases. Presently, no published reviews analyze all of the commonly available cushion materials. Most comparison studies typically address a specific population such as spinal cord injury, or only a few styles of cushion design/materials. Results suggest air-cell cushions provide optimal pressure relief and shear reduction. Furthermore, small sample single cohort studies suggest off-loading cushions provide superior pressure relief beyond that of air-celled cushions but require additional research for greater generalizability.
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Affiliation(s)
- John Damiao
- Occupational Therapy Department, Pace University, New York, New York, USA
| | - Tony Gentry
- Occupational Therapy Department, Virginia Commonwealth University, Richmond, Virginia, USA
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2
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Sober-Williams EK, Lee RHY, Whitehurst DGT, McBride CB, Willms R, Claydon VE. Bowel burdens: a systematic review and meta-analysis examining the relationships between bowel dysfunction and quality of life after spinal cord injury. Spinal Cord 2024; 62:495-506. [PMID: 39014196 PMCID: PMC11368817 DOI: 10.1038/s41393-024-01002-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 07/18/2024]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES Many individuals with spinal cord injury (SCI) experience autonomic dysfunction, including profound impairments to bowel and cardiovascular function. Neurogenic bowel dysfunction (NBD) is emerging as a potential determinant of quality of life (QoL) after SCI. For individuals with high-level lesions ( > T6), bowel care-related autonomic dysreflexia (B-AD; profound episodic hypertension) further complicates bowel care. We aimed to evaluate the extent of bowel dysfunction after SCI, and the impact of bowel dysfunction on QoL after SCI. METHODS We searched five databases to identify research assessing the influence of NBD or B-AD on QoL after SCI. Metrics of bowel dysfunction (fecal incontinence [FI], constipation, time to complete, and B-AD) and QoL data were extracted and synthesised. Where possible, meta-analyses were performed. RESULTS Our search identified 2042 titles, of which 39 met our inclusion criteria. Individuals with SCI identified problems with NBD (74.7%), FI (56.9%), and constipation (54.6%), and 49.3% of individuals with SCI > T6 experienced B-AD. Additionally, 40.3% of individuals experienced prolonged defecation ( > 30 min). Moderate/severe deterioration in QoL due to NBD was reported by 55.5% of individuals with SCI, with negative impacts on physical, emotional, and social health-related QoL associated with inflexibility of bowel routines, fear of accidents, and loss of independence. CONCLUSION Bowel dysfunction and bowel care challenges are prevalent and disabling for individuals with SCI, with a profoundly negative impact on QoL. Improving bowel management is a key target to improve QoL for those living with SCI.
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Affiliation(s)
- Elin K Sober-Williams
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Rebekah H Y Lee
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - David G T Whitehurst
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Rhonda Willms
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Centre, Spinal Cord Injury Program, Vancouver Coastal Health, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
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Dupitier EA, Perrier AP, Laforêt P, Pouplin SD. User opinions about connected pressure detection systems to prevent wheelchair-related pressure injuries: An exploratory cross-sectional survey. Assist Technol 2024; 36:275-284. [PMID: 38607290 DOI: 10.1080/10400435.2024.2335944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 04/13/2024] Open
Abstract
About 1% of the world's population uses a wheelchair. Wheelchair use is a well-known risk of pressure injury. A connected pressure detection system could help to prevent this complication that is linked to long durations of sitting, provided that user expectations are understood. The aim of this study was to explore the needs of wheelchair users (WU) regarding connected pressure detection systems to prevent pressure injury. A cross-section survey-based study of WU was conducted, using an anonymous electronic questionnaire posted from July 2019 to June 2020. Eighty-eight people responded. The majority were power wheelchair users (72.7%); one third (33.0%) had already sustained a pressure injury; only 17.0% knew of the existence of pressure detection systems, nevertheless 78.4% believed that they could be useful in daily life. The feature that received the highest rating was a pressure warning alarm (4.2/5 points). The majority (71.6%) preferred reminder-alerts to be set according to their habits and not according to medical guidelines. In conclusion, pressure detecting systems were perceived as useful to prevent pressure injuries by both manual and power wheelchair users. Work is needed to inform potential users of the existence of such systems.
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Affiliation(s)
- Elise A Dupitier
- Rehabilitation Research Team in Neuromotor Disability ERPHAN, Paris-Saclay University, Garches, France
- U 1179 National Institute of Health and Medical Research (INSERM), Paris-Saclay University, Versailles, France
- Medical Department, AFM-Téléthon, Evry, France
| | - Antoine P Perrier
- TIMC Lab, Biomeca Team, National Center for Scientific Research (CNRS), Grenoble Alpes University, Grenoble, France
- Orthopedic surgery, Hospital Group Diaconesses - Croix Saint-Simon, Paris, France
| | - Pascal Laforêt
- U 1179 National Institute of Health and Medical Research (INSERM), Paris-Saclay University, Versailles, France
- Neurology Department, Raymond Poincaré University Hospital, Garches, France
- Garches, Nord-Est-lle-de-France Neuromuscular Reference Center, FHU PHENIX, France
| | - Samuel D Pouplin
- Rehabilitation Research Team in Neuromotor Disability ERPHAN, Paris-Saclay University, Garches, France
- U 1179 National Institute of Health and Medical Research (INSERM), Paris-Saclay University, Versailles, France
- New Technologies Plateform, Raymond Poincaré University Hospital, Garches, France
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4
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Bai X, Liu Y, Dai Z, Chen Y, Fang P, Ma J. Determinants of Perceived Comfort: Multi-Dimensional Thinking in Smart Bedding Design. SENSORS (BASEL, SWITZERLAND) 2024; 24:4058. [PMID: 39000837 PMCID: PMC11243896 DOI: 10.3390/s24134058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/13/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Abstract
Sleep quality is an important issue of public concern. This study, combined with sensor application, aims to explore the determinants of perceived comfort when using smart bedding to provide empirical evidence for improving sleep quality. This study was conducted in a standard sleep laboratory in Quanzhou, China, from March to April of 2023. Perceived comfort was evaluated using the Subjective Lying Comfort Evaluation on a seven-point rating scale, and body pressure distribution was measured using a pressure sensor. Correlation analysis was employed to analyze the relationship between perceived comfort and body pressure, and multiple linear regression was used to identify the factors of perceived comfort. The results showed that body pressure was partially correlated with perceived comfort, and sleep posture significantly influenced perceived comfort. In addition, height, weight, and body mass index are common factors that influence comfort. The findings highlight the importance of optimizing the angular range of boards based on their comfort performance to adjust sleeping posture and equalize pressure distribution. Future research should consider aspects related to the special needs of different populations (such as height and weight), as well as whether users are elderly and whether they have particular diseases. The design optimization of the bed board division and mattress softness, based on traditional smart bedding, can improve comfort and its effectiveness in reducing health risks and enhancing health status.
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Affiliation(s)
- Xiangtian Bai
- School of Design, Hunan University, Changsha 410082, China
| | - Yonghong Liu
- School of Design, Hunan University, Changsha 410082, China
- Innovation Institute of Industrial Design and Machine Intelligence, Hunan University, Quanzhou 362006, China
| | - Zhe Dai
- School of Design, Hunan University, Changsha 410082, China
| | - Yongkang Chen
- College of Design and Innovation, Tongji University, Shanghai 200092, China
| | - Pingping Fang
- School of Design, Hunan University, Changsha 410082, China
| | - Jun Ma
- Xiangya School of Nursing, Central South University, Changsha 410013, China
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Müller R, Oette C, Oette C, Schreff L, Abel R. Sitting Pressure Measurements in Wheelchair Users-Can the Effects of Daily Relief Activities Be Depicted? SENSORS (BASEL, SWITZERLAND) 2024; 24:3806. [PMID: 38931590 PMCID: PMC11207960 DOI: 10.3390/s24123806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
Seat pressure measurements in wheelchair users have been available for some time; however, repeated measurements from a commercially available pressure mat over 90 min did not differ in the pressure-loaded measurement area or the coordinates of the center of pressure, even in participants who were able to reposition themselves in the wheelchair. The question therefore arises: to what extent are there other parameters that reflect the activity of wheelchair users with the pressure mat? To investigate this, a commercial pressure mat (BodiTrak®) was used to perform the measurements of pressure of 33 adult wheelchair-dependent people with spinal cord injury after 30 and 90 min sitting on the cushion. In addition to the standard output of the pressure mat, graph-based surface analyses (calculation of the area of maximum pressure, calculation of the pressure-loaded measurement area, and pressure-area ratio) was performed retrospectively using Python 3.7. The analysis of the measurements after 30 and 90 min was performed by distinguishing the participants between those who could actively change their position (N = 24) and those who could not (N = 9). The parameters of the pressure mat and the graph-based analyses remained unchanged for active participants. In participants who were unable to actively change their position, the area of maximum pressure and the pressure-area ratio (ratio of maximum pressure area and total pressure-loaded area) increased. Significant differences between minutes 30 and 90 are only found for the pressure-area ratio. Thus, when measuring the seat pressure of wheelchair users, the pressure-area ratio should be taken into account as it reflects the daily relief activities of wheelchair users.
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Affiliation(s)
- Roy Müller
- Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, 95445 Bayreuth, Germany; (C.O.); (L.S.); (R.A.)
- Bayreuth Center of Sport Science, University of Bayreuth, Universitätsstraße 30, 95447 Bayreuth, Germany
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen, 91054 Erlangen, Germany
| | - Clara Oette
- Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, 95445 Bayreuth, Germany; (C.O.); (L.S.); (R.A.)
| | - Cedric Oette
- Hawk Intelligent Technologies GmbH, Schafäckerlein 23, 91413 Neustadt an der Aisch, Germany
| | - Lucas Schreff
- Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, 95445 Bayreuth, Germany; (C.O.); (L.S.); (R.A.)
- Bayreuth Center of Sport Science, University of Bayreuth, Universitätsstraße 30, 95447 Bayreuth, Germany
| | - Rainer Abel
- Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, 95445 Bayreuth, Germany; (C.O.); (L.S.); (R.A.)
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen, 91054 Erlangen, Germany
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Sonenblum SE, McDonald A, Maurer CL, Bass A, Watson M, Zellner H. Reducing pressure with the goal of improving outcomes: a retrospective chart review of cushion evaluations and recommendations at one seating clinic. Disabil Rehabil Assist Technol 2024; 19:1552-1560. [PMID: 37177785 DOI: 10.1080/17483107.2023.2212012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE To describe the current seating recommendations made by a seating clinic for wheelchair users who presented with a Pressure Injury (PrI) or history of PrI. METHODS Retrospective review of electronic medical records of 133 adults who used a wheelchair as their primary means of mobility who had a cushion evaluation during which interface pressure mapping data was documented. RESULTS Clinicians adjusted 71% of participants' wheelchair cushions, including 49% who received a new cushion, and 37% of participants' wheelchairs. The most common adjustments besides receiving a new cushion were: addition of an underlay, adjusting the inflation of a cushion, and adjustments to the foot or back support of the wheelchair. Forty-five participants only received adjustments (i.e. no new cushion), while 23 participants only received education and feedback rather than equipment modifications. Those 23 participants had significantly lower Peak Pressure Index (PPI) than those who received equipment modifications (mean [95% CI] 76.7 [59.1, 94.3] versus 111.6 [102.1, 121.2] respectively, p = 0.001). The PPI was reduced by an average of 22.5 mmHg from the initial to final seating system amongst those who received modifications ([13.9-31.0], p<.001). CONCLUSIONS The seating clinicians considered interface pressure mapping in their decision-making and effectively reduced interface pressures with their interventions. Cushion replacement is important when someone presents with a PrI. However, adjusting an existing wheelchair cushion and/or seating system provides important additions and alternatives to consider for reducing interface pressure. There is also a role for education about proper use of equipment, weight shifts, and alternate seating surfaces.
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Affiliation(s)
- Sharon Eve Sonenblum
- George W. Woodruff School of Mechanical Engineering, GA Institute of Technology, Atlanta, GA, USA
| | | | | | - Amber Bass
- Division of Physical Therapy, Emory School of Medicine, Atlanta, GA, USA
| | - Marigny Watson
- Division of Physical Therapy, Emory School of Medicine, Atlanta, GA, USA
| | - Haley Zellner
- Division of Physical Therapy, Emory School of Medicine, Atlanta, GA, USA
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Morrow MM, Hughes LC, Collins DM, Vos-Draper TL. Clinical Remote Monitoring of Individuals With Spinal Cord Injury at Risk for Pressure Injury Recurrence Using mHealth: Protocol for a Pilot, Pragmatic, Hybrid Implementation Trial. JMIR Res Protoc 2024; 13:e51849. [PMID: 38598267 PMCID: PMC11043927 DOI: 10.2196/51849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Pressure injuries are one of the most challenging secondary conditions for individuals with spinal cord injuries and related disorders (SCI/D) owing to inherent, lifelong risk factors that include a lack of sensory and motor function below the level of injury and reliance on a wheelchair for daily mobility, resulting in prolonged periods of sitting. Although many factors contribute to the development of pressure injuries, the pressure between the skin and a surface is always a factor and the development of injury is dependent on the magnitude and duration of the pressure. Clinically, broad recommendations for relieving pressure are used because we know very little about the unique day-to-day life patterns of the individual wheelchair user. Typically, it is after the occurrence of a pressure injury that the therapist will check equipment fit and the effectiveness of pressure offloading and ask about other surfaces they sit on in their home and community. This time-lapsed, largely self-reported data are fraught with recall bias and inaccuracies that the therapist incorporates into a plan of care. OBJECTIVE This study's objective is to pilot-test the implementation and clinical effectiveness of a telehealth model of care combined with our mobile health (mHealth) Assisted Weight-Shift device for remote monitoring of factors related to maintaining skin health and wheelchair setup. Our overall hypothesis is that this study will result in an effective implementation plan, and the enhanced connected model of care using remote monitoring of pressure management will result in pilot-level, improved clinical outcomes for adults with spinal cord injury at high risk for pressure injury recurrence. METHODS For all aims, we will use a mixed methods design using an exploratory, sequential approach to include the strengths of both qualitative and quantitative data. For aims 1 and 2, we will iteratively collect qualitative data from therapists, patients with SCI/D, and other stakeholders. For aim 3, we will perform a hybrid effectiveness-implementation randomized controlled trial to pilot-test the intervention. The projected results include an iteratively developed and tested implementation plan that meets moderate to high levels of acceptability, feasibility, and appropriateness. Additionally, the pilot trial results are expected to show positive trends in relevant clinical outcomes related to reduced pressure injury incidence, recurrence, and improved healing when compared with the standard of care. RESULTS Currently, 6 participants have been recruited for our aim-1 qualitative study. CONCLUSIONS This study will expand upon our previous study to move the Assisted Weight-Shift system into routine clinical care, which was a strong desire of adults with SCI/D for improved individualized care plans to prevent pressure injuries. The results of this study will guide the next steps in a full, hybrid effectiveness-implementation trial with the goal of improving care to prevent pressure injuries. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51849.
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Affiliation(s)
- Melissa M Morrow
- Department of Physical Therapy & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Lynne C Hughes
- Department of Physical Therapy & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Diane M Collins
- Department of Physical Therapy & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Tamara L Vos-Draper
- College of Pharmacy, Program in Occupational Therapy, University of Minnesota, Minneapolis, MN, United States
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8
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Sonenblum SE, Feng C, Sprigle S. The relationship between in-seat movement and pressure ulcers in wheelchair users with SCI/D. J Spinal Cord Med 2024; 47:91-99. [PMID: 36260494 PMCID: PMC10795617 DOI: 10.1080/10790268.2022.2122340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To identify parameters that are associated with time at pressure, are most related to pressure ulcer outcomes, and that may be used to influence pressure ulcer (PrU) outcomes in future intervention studies. DESIGN Analysis used datasets from cross-sectional and longitudinal observational studies. Wheelchair-usage and in-seat metrics thresholds were optimized to differentiate individuals in PrU or No PrU groups. Logistic regression identified the demographics and in-seat activity metrics that impacted PrU outcomes. SETTING General Community. PARTICIPANTS Fifty individuals with spinal cord injuries and/or disorders (SCI/D) who use a wheelchair as their primary mobility device. 22 subjects were within the first year following injury and 28 had been using a wheelchair for over 2 years. Twenty-one participants reported PrU outcomes. INTERVENTIONS Not applicable. OUTCOME MEASURES Time in chair, pressure relief frequency, weight shift frequency, percentage of seated time that the subject is active (CoP Percent Active), frequency of in-seat movement, unloading event frequency, maximum time between events, and number of transfers. RESULTS Optimal cutoff thresholds for the most significant in-seat movement metrics included: unloading event frequency of 3.1 times per hour (OR 0.353, 95% CI [0.110, 1.137]), maximum time between events of 155.4 min (OR 2.888, 95% CI [0.886, 9.413]), and CoP Percent Active of 2.6% (OR 0.221, 95% CI [0.063, 0.767]). When individuals were more active than these cutoffs, significantly more individuals were in the no pressure ulcer group. In predictive modeling, CoP Percent Active was the in-seat movement metric that significantly predicted PrU outcomes. The model was improved by adding age, occupation, and injury completeness. CONCLUSION Of the 4 significant predictors in the model, only CoP Percent Active was modifiable. Therefore, an opportunity exists to design approaches to modify behavior. However, the results illustrate that the key to preventative movement may be through functional movement as opposed to scheduled, routine pressure reliefs.
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Affiliation(s)
- Sharon Eve Sonenblum
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Chen Feng
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Stephen Sprigle
- Rehabilitation Engineering and Applied Research Lab, Georgia Institute of Technology, Atlanta, Georgia, USA
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Blanchard J, Vigen C, Mallinson T, Carlson M, Garber SL, Bates-Jensen B. Pressure Injury Data Reconciliation in a Randomized Controlled Trial. Arch Phys Med Rehabil 2023; 104:1833-1839. [PMID: 37121533 PMCID: PMC10611896 DOI: 10.1016/j.apmr.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/01/2023] [Accepted: 04/07/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To advance pressure injury (PrI) research in individuals with spinal cord injury (SCI) by describing lessons learned and recommendations for future research, ultimately promoting PrI prevention and more effective wound care. This paper describes the detailed procedures undertaken to collect and reconcile PrI data and summarizes the types of discrepancies identified. DESIGN Secondary analyses of PrI data collected between 2009 and 2014 in a randomized controlled trial (parent study). SETTING Participants in the parent study were recruited from a large rehabilitation center in the Los Angeles area that serves primarily individuals with limited resources. PARTICIPANTS 232 participants with SCI and a history of 1 or more medically serious PrI (MSPrI) in the previous 5 years. INTERVENTIONS Participants in the parent study were randomized to a 12-month PrI prevention intervention led by an occupational therapist, or to usual care. MAIN OUTCOME MEASURES Relations among PrI characteristics, data sources (phone interviews, skin checks, paper and electronic medical records [MRs]), and treatment condition, and sensitivity of 6 different data sources in detecting MSPrIs. RESULTS The majority (62%) of MSPrIs were in the pelvic region. MRs detected 82% of the MSPrIs overall, making it the most sensitive data source, and scheduled skin checks were the second-most sensitive data source, finding 37% of the MSPrIs. CONCLUSIONS MR review is the preferred method for ascertaining MSPrIs in clinical trials of interventions designed to reduce the incidence of these injuries. When multiple sources of information are used, careful reconciliation of reports is necessary to ensure accuracy.
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Affiliation(s)
- Jeanine Blanchard
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA.
| | - Cheryl Vigen
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Trudy Mallinson
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Mike Carlson
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Susan L Garber
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX
| | - Barbara Bates-Jensen
- School of Nursing and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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10
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Dupitier E, Voisin M, Stalens C, Laforêt P, Pouplin S. Identification of wheelchair seating criteria in adults with neuromuscular diseases: A Delphi study. PLoS One 2023; 18:e0290627. [PMID: 37682819 PMCID: PMC10490879 DOI: 10.1371/journal.pone.0290627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/13/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Adults with neuromuscular diseases like spinal muscular atrophy or Duchenne muscular dystrophy require full-time use of a wheelchair (WC) and perform all activities of daily living in a sitting position. Optimal configuration of the WC and seating system is essential to maintain the health and quality of life of users. However, few recommendations for configuration exist. The aim of this study was to identify and select 10 WC seating criteria that ensure an optimal sitting posture for health and quality of life. METHODS A four round Delphi method was used to collect the opinions of WC users and health professionals (HP), separately. First, the HP were asked if they believed that different criteria would apply to each disease. Then the HP and SMA II and DMD WC user experts responded to electronic surveys in 4 rounds. RESULTS Overall, 74 experts took part: 31 HP, 21 WC users with SMA II and 22 WC users with DMD. In total, 52% of HP believed that different criteria would apply to each disease. Ten criteria were identified by the HP for SMA II and 10 for DMD. Of the 40 criteria selected, 30 (75%) were common to each panel. Six topics were similar across panels: comfort, access to the joystick, prevention of pain, stability, pressure management and power seat functions. However, power seat functions did not reach consensus between HP and WC users (30-33% of agreement for HP and 93-100% for the WC user panels, p < 0.001). CONCLUSION Adults with SMA II and DMD had similar WC seating needs. Therefore, the same recommendations can be applied to these groups. Further research is necessary to understand the impact of cost on the prescription of power seat functions by health professionals.
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Affiliation(s)
- Elise Dupitier
- UR2020 ERPHAN, Paramedical Research Team in Neuromuscular Disability, Paris—Saclay University, University Hospital Site of Raymond Poincaré, Garches, France
- UFR Simone Veil-Santé, UMR 1179 End-iCap, Paris—Saclay University, University Hospital Site of Raymond Poincaré, Garches, France
- Medical Department, AFM-Téléthon, Evry, France
| | | | | | - Pascal Laforêt
- UFR Simone Veil-Santé, UMR 1179 End-iCap, Paris—Saclay University, University Hospital Site of Raymond Poincaré, Garches, France
| | - Samuel Pouplin
- UR2020 ERPHAN, Paramedical Research Team in Neuromuscular Disability, Paris—Saclay University, University Hospital Site of Raymond Poincaré, Garches, France
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11
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Goodwin BM, Olney CM, Ferguson JE, Hansen AH, Eddy B, Goldish G, Morrow MM, Vos-Draper TL. Visualization of user interactions with a pressure mapping mobile application for wheelchair users at risk for pressure injuries. Assist Technol 2022; 34:444-453. [PMID: 33395558 PMCID: PMC8433259 DOI: 10.1080/10400435.2020.1862938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Pressure injuries for individuals with spinal cord injuries (SCI) are correlated with mortality and are a leading cause for rehospitalizations. The Assisted Weight Shift (AW-Shift©) is a mobile pressure mapping application designed to provide users with a live map view and reminders to perform weight shifts. Novel visualization techniques were used to understand daily distributions of user interaction wit h AW-Shift©. The date and time of system interactions were recorded for six participants with SCI over 7 days (five males/one female, five manual users/one power user, 55.3 ± 17.3 years old, 10.6 ± 6.5 years since injury). Circular frequency plots were created to visualize the time and frequency participants brought the app to the foreground of their phone and received alerts and reminders to complete weight shifts. While some participants used the system regularly throughout the day, others primarily used it before 8am; highlighting the system's importance for regular spot checks and morning wheelchair setup. Participant adherence to weight shift reminders was low suggesting the live pressure map may be more useful. Circular frequency plots can be used by clinicians to more easily review large amounts of patient data. Future work will investigate raw pressure mat data and create a closed-loop weight shift detection algorithm.
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Affiliation(s)
- Brianna M. Goodwin
- Division of Health Care Policy and Research, Department of Health Sciences Research Mayo Clinic, Rochester, Minnesota, USA,Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
| | - Christine M. Olney
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA,College of Design, University of Minnesota, Minneapolis, Minnesota, USA
| | - John E. Ferguson
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA,Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew H. Hansen
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA,Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Byron Eddy
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA,Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gary Goldish
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA,Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Melissa M. Morrow
- Division of Health Care Policy and Research, Department of Health Sciences Research Mayo Clinic, Rochester, Minnesota, USA,Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
| | - Tamara L. Vos-Draper
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA,Center for Allied Health Professions, Program in Occupational Therapy, University of Minnesota, Minneapolis, Minnesota, USA
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Warren-Smith SC, Kilpatrick AD, Wisal K, Nguyen LV. Multimode optical fiber specklegram smart bed sensor array. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:067002. [PMID: 35751142 PMCID: PMC9231555 DOI: 10.1117/1.jbo.27.6.067002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
SIGNIFICANCE Monitoring the movement and vital signs of patients in hospitals and other healthcare environments is a significant burden on healthcare staff. Early warning systems using smart bed sensors hold promise to relieve this burden and improve patient outcomes. We propose a scalable and cost-effective optical fiber sensor array that can be embedded into a mattress to detect movement, both sensitively and spatially. AIM Proof-of-concept demonstration that a multimode optical fiber (MMF) specklegram sensor array can be used to detect and image movement on a bed. APPROACH Seven MMFs are attached to the upper surface of a mattress such that they cross in a 3 × 4 array. The specklegram output is monitored using a single laser and single camera and movement on the fibers is monitored by calculating a rolling zero-normalized cross-correlation. A 3 × 4 image is formed by comparing the signal at each crossing point between two fibers. RESULTS The MMF sensor array can detect and image movement on a bed, including getting on and off the bed, rolling on the bed, and breathing. CONCLUSIONS The sensor array shows a high sensitivity to movement, which can be used for monitoring physiological parameters and patient movement for potential applications in healthcare settings.
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Affiliation(s)
- Stephen C. Warren-Smith
- University of South Australia, Future Industries Institute, Mawson Lakes, South Australia, Australia
- The University of Adelaide, Institute for Photonics and Advanced Sensing, School of Physical Sciences, Adelaide, South Australia, Australia
- The University of Adelaide, Australian Research Council Centre of Excellence for Nanoscale Biophotonics, Adelaide, South Australia, Australia
| | - Adam D. Kilpatrick
- The University of Adelaide, Adelaide Nursing School, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kabish Wisal
- Yale University, Department of Physics, New Haven, Connecticut, United States
| | - Linh V. Nguyen
- University of South Australia, Future Industries Institute, Mawson Lakes, South Australia, Australia
- The University of Adelaide, Institute for Photonics and Advanced Sensing, School of Physical Sciences, Adelaide, South Australia, Australia
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Langemo D, Anderson J, Hanson D, Thompson P, Johnson E. The Conundrum of Turning/Repositioning Frequency, Sleep Surface Selection, and Sleep Disruption in Preventing Pressure Injury in Healthcare Settings. Adv Skin Wound Care 2022; 35:252-259. [PMID: 35442917 DOI: 10.1097/01.asw.0000824780.10098.d1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Diane Langemo
- Diane Langemo, PhD, RN, FAAN, is Distinguished Professor Emeritus, College of Nursing and Professional Development, University of North Dakota, Grand Forks, United States. Julie Anderson, PhD, RN, is Dean, Winona State University, Minnesota. Also at the University of North Dakota, Darlene Hanson, PhD, RN, is Clinical Professor, College of Nursing and Professional Development; Patricia Thompson, MS, RN, is Clinical Assistant Professor, College of Nursing and Professional Development; and Erika Johnson, MLIS, is Clinical Campus Librarian, School of Medicine and Health Sciences. Submitted June 8, 2021; accepted in revised form October 20, 2021
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Karadağ A, Çakar V. Evidence-Based Prevention and Management of Pressure Injuries in Home Care: A Scoping Review. Adv Skin Wound Care 2022; 35:172-179. [PMID: 35188484 DOI: 10.1097/01.asw.0000815484.50141.5d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the presence of evidence-based practice protocols for the prevention and management of pressure injuries (PIs) in home care settings, whether the contents of existing protocols were based on current evidence, and adherence to these protocols. DATA SOURCES Comprehensive and structured literature searches were conducted using PubMed, Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO, Ovid, Scopus, Web of Science, and Joanna Briggs Institute Evidence-Based Practice Database. STUDY SELECTION A literature search retrieved 2,929 articles. Investigators evaluated the titles, abstracts, and full texts of the articles retrieved from the literature search in accordance with the review questions and eligibility criteria. The authors included four studies in this scoping review. DATA EXTRACTION The researchers extracted details of the full-text articles, including author(s)/year of publication/country, aim(s), study population and sample size, study design, intervention type, outcomes, and key findings. DATA SYNTHESIS The four articles included in this scoping review are descriptive cross-sectional studies published between 2005 and 2010. Although the articles provided significant data on the quality of practices for the prevention and management of PIs in home care, no studies reported on the achievement of objective results. CONCLUSIONS The use of protocols for the prevention and management of PIs, including evidence-based interventions in home care, and adherence to existing protocols were low. Comprehensive observational and randomized controlled studies are necessary to improve evidence-based prevention and management of PIs in home care settings.
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Affiliation(s)
- Ayişe Karadağ
- At Koç University, Istanbul, Turkey, Ayişe Karadağ, PhD, RN, ET/WOCN, is Professor, School of Nursing; and Vildan Çakar, MS, RN, is Research Assistant, Graduate School of Health Sciences. Acknowledgments: The authors thank Ertaç Nebioğlu, librarian at Koç University Suna Kıraç Library for his assistance, support, and contributions. The authors have disclosed no financial relationships related to this article. Submitted February 18, 2021; accepted in revised form April 16, 2021
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Sensor Cell Network for Pressure, Temperature and Position Detection on Wheelchair Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042195. [PMID: 35206382 PMCID: PMC8872115 DOI: 10.3390/ijerph19042195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 11/19/2022]
Abstract
This work proposes an optical sensing network to monitor pressure and temperature in specific areas of a wheelchair to prevent pressure ulcers and to monitor the position of the wheelchair user by analyzing its pressure distribution. The sensing network is composed of six optical fiber Bragg grating (FBG)-based sensor cells. Each sensor cell is built from a polylactic acid (PLA) base and has two FBGs, one embedded in epoxy resin to monitor pressure variations (FBGP) and another without resin to monitor temperature (FBGT). Once produced, all sensor cells were experimentally characterized for pressure and temperature variations, resulting in an average pressure sensitivity of 81 ± 5 pm/kPa (FBGP) and −5.0 ± 0.4 pm/kPa (FBGT), and an average temperature sensitivity of 25 ± 1 pm/°C (FBGP) and 47.7 ± 0.7 pm/°C (FBGT). The sensor cells were then placed in six specific areas of a wheelchair (four in the seat area and two in the shoulder blade area) to carry out experimental tests, wherein the response of the sensors to a specific sequence of relief positions was tested. During the execution of the test, the optical signal of all sensors was monitored, in real time, with the pressure and temperature values detected in each zone of the wheelchair. In addition, random position changes were performed in order to evaluate the precision of the proposed sensing network in the identification of such positions.
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A Blanket Accommodative Sleep Posture Classification System Using an Infrared Depth Camera: A Deep Learning Approach with Synthetic Augmentation of Blanket Conditions. SENSORS 2021; 21:s21165553. [PMID: 34450994 PMCID: PMC8402261 DOI: 10.3390/s21165553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023]
Abstract
Surveillance of sleeping posture is essential for bed-ridden patients or individuals at-risk of falling out of bed. Existing sleep posture monitoring and classification systems may not be able to accommodate the covering of a blanket, which represents a barrier to conducting pragmatic studies. The objective of this study was to develop an unobtrusive sleep posture classification that could accommodate the use of a blanket. The system uses an infrared depth camera for data acquisition and a convolutional neural network to classify sleeping postures. We recruited 66 participants (40 men and 26 women) to perform seven major sleeping postures (supine, prone (head left and right), log (left and right) and fetal (left and right)) under four blanket conditions (thick, medium, thin, and no blanket). Data augmentation was conducted by affine transformation and data fusion, generating additional blanket conditions with the original dataset. Coarse-grained (four-posture) and fine-grained (seven-posture) classifiers were trained using two fully connected network layers. For the coarse classification, the log and fetal postures were merged into a side-lying class and the prone class (head left and right) was pooled. The results show a drop of overall F1-score by 8.2% when switching to the fine-grained classifier. In addition, compared to no blanket, a thick blanket reduced the overall F1-scores by 3.5% and 8.9% for the coarse- and fine-grained classifiers, respectively; meanwhile, the lowest performance was seen in classifying the log (right) posture under a thick blanket, with an F1-score of 72.0%. In conclusion, we developed a system that can classify seven types of common sleeping postures under blankets and achieved an F1-score of 88.9%.
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Bai DL, Liu TW, Chou HL, Hsu YL. Relationship between a pressure redistributing foam mattress and pressure injuries: An observational prospective cohort study. PLoS One 2020; 15:e0241276. [PMID: 33166300 PMCID: PMC7652312 DOI: 10.1371/journal.pone.0241276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/12/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND PURPOSE Pressure injuries remain a significant health care issue in various settings. The purpose of this study was to examine the relationship between a pressure redistributing foam mattress (PRFM) and the development of pressure injuries. METHODS This study employed an observational prospective cohort study design. We enrolled 254 participants from the intensive care unit who were at risk of developing pressure injuries. Participants were exposed to either a nonpressure redistributing foam mattress (NPRFM), which was the standard mattress used at the study site, or a PRFM made of viscoelastic, temperature-sensitive, polyurethane memory foam. The patients' assignment to either a PRFM or NPRFM was performed upon their admission, before the study eligibility screening. The relationship between the PRFM and the development of pressure injuries was studied using a logistic regression model. RESULTS The overall incidence of pressure injuries was 5.9% (15/254) in our study, with 1.6% (2/127) for participants who used a PRFM and 10.2% (13/127) for those using a NPRFM. After adjusting for potential confounding variables, use of a PRFM was associated with an 88% reduced risk of pressure injury development (OR = 0.12, 95% CI: 0.03, 0.56, P = 0.007). The use of a PRFM also contributed to a postponed occurrence of pressure injuries by 4.2 days on average in comparison with that of a NPRFM (P = 0.041). CONCLUSIONS A PRFM is associated with a significantly reduced incidence and postponed occurrence of pressure injuries. It is recommended to use a PRFM for patients at risk of developing pressure injuries.
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Affiliation(s)
- Dorothy Li Bai
- Gerontechnology Research Center, Yuan Ze University, Taoyuan, Taiwan
| | - Tsai-Wen Liu
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsiu-Ling Chou
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Yeh-Liang Hsu
- Gerontechnology Research Center, Yuan Ze University, Taoyuan, Taiwan
- Mechanical Engineering Department, Yuan Ze University, Taoyuan, Taiwan
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Results of Laboratory Testing for Immersion, Envelopment, and Horizontal Stiffness on Turn and Position Devices to Manage Pressure Injury. Adv Skin Wound Care 2020; 33:S11-S22. [DOI: 10.1097/01.asw.0000696412.04000.98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stanglmeier MJ, Paternoster FK, Paternoster S, Bichler RJ, Wagner PO, Schwirtz A. Automated driving: A biomechanical approach for sleeping positions. APPLIED ERGONOMICS 2020; 86:103103. [PMID: 32342893 DOI: 10.1016/j.apergo.2020.103103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/31/2020] [Accepted: 03/23/2020] [Indexed: 06/11/2023]
Abstract
Occupants of autonomous vehicle have frequently indicated the desire to sleep or rest while driving, yet little has been known regarding the suitable design criteria for a biomechanically reasoned in-vehicle sleeping position. This study was aimed at evaluating the biomechanical quality of different backrest and seat pan angle combinations, and at predicting the most favourable sleeping positions based on vehicle restriction. More specifically, the interface pressure distribution and subjective suitability rating of 23 subjects was assessed in a total of nine (3 × 3) combinations of seat pan (20°, 30°, 40°) and backrest (145°, 155°, 165°) angles. Biomechanical quality was evaluated with an interface pressure score (IPS) based on sensitivity weighted pressures and the total contact area. Two-way repeated measures ANOVA revealed that IPS significantly improves with increasing seat pan angle whereas backrest angles of 155° or 165° lead to significant better IPS compared to flatter ones (145°). The overall highest IPS was observed for a 40°-seat pan angle in combination with a 155°-backrest angle. Subjective suitability rating revealed that people prefer a combination of 165° backrest angle with a seat pan of 20°; however, eight of nine combinations can be considered as suitable for sleeping. Therefore, the combination of a 40°-seat pan angle and 155° backrest is recommended by the present study for an in-vehicle sleeping position due to the increased biomechanical quality.
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Affiliation(s)
- Maximilian J Stanglmeier
- BMW Group, Knorrstraße 147, 80788, München, Germany; Department of Biomechanics in Sports, Technical University of Munich, Uptown München-Campus D, Georg-Brauchle-Ring 60/62, 80992, München, Germany.
| | - Florian K Paternoster
- Department of Biomechanics in Sports, Technical University of Munich, Uptown München-Campus D, Georg-Brauchle-Ring 60/62, 80992, München, Germany
| | | | | | | | - Ansgar Schwirtz
- Department of Biomechanics in Sports, Technical University of Munich, Uptown München-Campus D, Georg-Brauchle-Ring 60/62, 80992, München, Germany
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Bernal Monroy E, Polo Rodríguez A, Espinilla Estevez M, Medina Quero J. Fuzzy monitoring of in-bed postural changes for the prevention of pressure ulcers using inertial sensors attached to clothing. J Biomed Inform 2020; 107:103476. [PMID: 32562894 DOI: 10.1016/j.jbi.2020.103476] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/09/2020] [Accepted: 06/03/2020] [Indexed: 11/29/2022]
Abstract
Postural changes while maintaining a correct body position are the most efficient method of preventing pressure ulcers. However, executing a protocol of postural changes over a long period of time is an arduous task for caregivers. To address this problem, we propose a fuzzy monitoring system for postural changes which recognizes in-bed postures by means of micro inertial sensors attached to patients' clothes. First, we integrate a data-driven model to classify in-bed postures from the micro inertial sensors which are located in the socks and t-shirt of the patient. Second, a knowledge-based fuzzy model computes the priority of postural changes for body zones based on expert-defined protocols. Results show encouraging performance in the classification of in-bed postures and high adaptability of the knowledge-based fuzzy approach.
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Abstract
BACKGROUND Selective use of pressure-redistributing support surfaces is considered an essential component of a pressure injury prevention bundle. Critically ill children who are too big for an isolette but too little for a bed are usually placed in critical care cribs that have unique features such as moveable side rails and a built-in scale for weighing the patient, but they do not have a mattress designed to redistribute pressure. The primary aim of this quality improvement project was to evaluate a pressure redistribution mattress designed for use in critical care cribs. CASES We retrospectively reviewed 22 charts of critically ill pediatric patients who participated in a product trial completed over a 12-week period in a stand-alone children's hospital in the Western United States. We reviewed demographic data, skin assessments, Braden Q Scale score, and support surface use. Our review revealed no pressure injury occurrences over the 12-week data collection period. CONCLUSIONS Findings from this quality improvement project suggest that the pressure-redistributing mattress, when used as part of an intervention bundle, prevents pressure injuries in critically ill pediatric patients.
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Wheelchair Tilt-in-Space and Recline Functions: Influence on Sitting Interface Pressure and Ischial Blood Flow in an Elderly Population. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4027976. [PMID: 30956981 PMCID: PMC6431370 DOI: 10.1155/2019/4027976] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/14/2018] [Accepted: 02/12/2019] [Indexed: 01/23/2023]
Abstract
Pressure ulcers (PUs) result from localised injury to the skin and underlying tissue and usually occur over a bony prominence as a result of pressure, often in combination with shear forces. Both pressure magnitude and duration are thought to be key risk factors in the occurrence of PUs, thus exposing wheelchair-bound subjects to high risk of PU development. As a result, wheelchairs that incorporate tilt-in-space and recline functions are routinely prescribed to redistribute pressure away from their ischial tuberosities. The goal of this study was to analyse the role of full-body tilt and recline angles in governing sitting interface pressure and blood circulation parameters in elderly subjects and thereby investigate the efficacy of tilt-in-space wheelchairs for aiding pressure relief activity. Sitting interface pressure and ischial blood flow parameters were examined in 20 healthy elderly subjects while seated in a tilt-in-space and recline wheelchair. Five different angles of seat tilt (5°, 15°, 25°, 35°, and 45°) were assessed in combination with three different angles of backrest recline (5°, 15°, and 30°). The results of the study show that when compared to the upright reference posture, every position (except 15°T/5°R) resulted in a significant decrease in sitting interface pressure. Ischial blood flow also showed significant increases at four different positions (45°T/15°R, 15°T/30°R, 35°T/30°R, and 45°T/30°R) but only at larger tilt-in-space and recline angles. The results therefore suggest that small tilt-in-space and recline angles are indeed able to reduce sitting interface pressures, whereas changes in ischial blood flow only occur at larger angles. In the literature, cell deformation is thought to be dominant over tissue ischemia in the development of tissue necrosis and PUs. Therefore, together with our findings it can be concluded that frequently undertaking small adjustments in tilt-in-space and recline angle might be important for preventing cell deformation and any associated cell necrosis. Larger angles of tilt-in-space and recline seem to support blood flow returning to the tissues, which is likely to play a positive role in healing damaged tissue.
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Sonenblum SE, Ma J, Sprigle SH, Hetzel TR, McKay Cathcart J. Measuring the impact of cushion design on buttocks tissue deformation: An MRI approach. J Tissue Viability 2018; 27:162-172. [DOI: 10.1016/j.jtv.2018.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 04/06/2018] [Accepted: 04/23/2018] [Indexed: 12/17/2022]
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Olney CM, Simone A, Hanowski K, Rector TS, Goldish GD, Hansen AH, Ferguson JE. Microclimate evaluation of strap-based wheelchair seating systems for persons with spinal cord injury: A pilot study. J Tissue Viability 2018; 27:181-187. [PMID: 30008299 DOI: 10.1016/j.jtv.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/05/2018] [Accepted: 06/09/2018] [Indexed: 11/17/2022]
Abstract
STUDY PURPOSE The purpose of this pilot study was to assess microclimate characteristics of two versions of a strap-based wheelchair seating system (perforated and solid straps) and to conduct preliminary microclimate comparisons of subjects' current wheelchair seating systems. MATERIALS AND METHODS In this pilot study, the microclimate properties of two variations (solid and perforated) of a strap-based seating system were compared with two commonly used seating systems. Six subjects sat on three different seating systems each for 100-min test periods, while temperature and relative humidity were measured with a single sensor adjacent to the skin-seat interface. Additionally, thermal images of the seat interface were collected before and after each test period. RESULTS The thermal images revealed that the maximum surface temperature of the solid-strap-based seating system was significantly lower than the other seating systems, -1.21 °C. (95% CI -2.11 to -0.30, p = 0.02), immediately following transfer out of the seat. Five minutes after transferring out of the seat, the perforated-strap seat was significantly cooler than the other seats -0.94 °C. (95% CI -1.59 to -0.30), p = 0.01, as was the solid-strap-based seat, -1.66 °C. (95% CI -2.69 to -0.63), p = 0.01. There were no significant differences in interface temperature or relative humidity measured with the single sensor near the skin-seat interface. CONCLUSION This pilot study offers preliminary evidence regarding the microclimate of the strap-based seating systems compared with other common seating systems. Clinically, the strap-based seating system may offer another option for those who struggle with microclimate management.
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Affiliation(s)
- Christine M Olney
- 1 Veterans Drive (151), Minneapolis VA Health Care System, Minneapolis, MN, 55417, USA.
| | - Amanda Simone
- 1 Veterans Drive (151), Minneapolis VA Health Care System, Minneapolis, MN, 55417, USA
| | - Kristin Hanowski
- 1 Veterans Drive (151), Minneapolis VA Health Care System, Minneapolis, MN, 55417, USA
| | - Thomas S Rector
- 1 Veterans Drive (151), Minneapolis VA Health Care System, Minneapolis, MN, 55417, USA
| | - Gary D Goldish
- 1 Veterans Drive (151), Minneapolis VA Health Care System, Minneapolis, MN, 55417, USA; Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Andrew H Hansen
- 1 Veterans Drive (151), Minneapolis VA Health Care System, Minneapolis, MN, 55417, USA; Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, 55455, USA
| | - John E Ferguson
- 1 Veterans Drive (151), Minneapolis VA Health Care System, Minneapolis, MN, 55417, USA; Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, 55455, USA
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A Survey of Canadian Occupational Therapy Practices to Prevent Pressure Injuries Among Wheelchair Users via Weight Shifting. J Wound Ostomy Continence Nurs 2018; 45:213-220. [PMID: 29722750 DOI: 10.1097/won.0000000000000428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to describe occupational therapy weight-shifting practices and explore recommended strategies for patients, healthcare staff, and family/caregivers across healthcare settings. DESIGN Cross-sectional survey. SUBJECTS AND SETTING Respondents included 97 currently practicing occupational therapists working in 5 main practice settings (ie, acute care, inpatient rehabilitation, outpatient rehabilitation, home and community care, and residential) from 9 out of 10 Canadian provinces. METHODS We created a 25-item questionnaire that included forced choice and open-ended queries. Items queried demographic information, weight-shifting techniques taught to patients, frequency and duration of weight shifting recommended, educational approaches used to teach weight shifting, and resources used to guide decision making. Participants were recruited via professional organizations and health authorities across Canada. Participants were excluded if they were not currently working with manual or power wheelchair users. Descriptive statistics were used to analyze quantitative data, and content analysis was used for qualitative data (responses to open-ended queries). RESULTS The most frequently recommended weight-shifting techniques were tilt (83.3%-92.8%), leaning to one side (47.9%-87.5%), and forward leaning (46.9%-83.3%). Study findings revealed a wide range of recommendations regarding frequency (every 10 minutes or less to >2 to 3 hours) and duration (≤30 seconds to as long as tolerated) of weight shifting. Weight-shifting interventions were most commonly guided by clinical experience (81.7%), practice guidelines (62.4%), and expertise of other team members (54.8%). CONCLUSIONS Results from this study highlight the need for further research to inform weight-shifting techniques and to build a more comprehensive understanding of weight-shifting education practices.
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Ceylan B, Yapucu Gunes U, Uyar M. Examination of sacral tissue oxygen saturation among immobile patients. J Clin Nurs 2018; 27:3641-3651. [DOI: 10.1111/jocn.14218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Burcu Ceylan
- Department of Fundamentals of Nursing; Faculty of Health Sciences; Izmir Katip Celebi University; Cigli Izmir Turkey
| | - Ulku Yapucu Gunes
- Fundamentals of Nursing Department; Faculty of Nursing; Ege University; Bornova Izmir Turkey
| | - Mehmet Uyar
- Anesthesia and Reanimation Department; Medical Faculty; Ege University; Bornova Izmir Turkey
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Jocelyn Chew H, Thiara E, Lopez V, Shorey S. Turning frequency in adult bedridden patients to prevent hospital-acquired pressure ulcer: A scoping review. Int Wound J 2018; 15:225-236. [PMID: 29243356 PMCID: PMC7949701 DOI: 10.1111/iwj.12855] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/07/2017] [Accepted: 10/11/2017] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to identify current research on turning frequencies of adult bed-bound patients and inform future turning practices for hospitals based on evidence-based practice. We undertook a scoping review framework that provided a transparent and systematic methodology using 8 electronic databases (CINAHL, PubMed, Cochrane Library, ScienceDirect, PsycINFO, Scopus, ProQuest, and Web of Science) to identify articles published from 2000 to 2016. Articles were included if they focused on the prevention of hospital-acquired pressure ulcers related to the frequency of turning or repositioning of bed-bound patients. Literature search and data extraction were performed independently by 3 authors. The study followed the PRISMA guidelines. In total, 911 articles were identified, of which 10 were eligible. Of the eligible articles, 8 studies could not reach a conclusion on the effective frequency of turning and duration for repositioning patients to prevent the development of pressure ulcers. Only 2 studies found significant differences among the intervention and control groups. Results regarding turning and repositioning schedules are inconclusive; however, the topic needs further exploration to improve the outdated guidelines surrounding pressure ulcer prevention. This may, in turn, make the work of nurses more efficient and make treatment cost-effective for both the patients and the hospitals.
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Affiliation(s)
- H‐S Jocelyn Chew
- The Nethersole School of NursingChinese University of Hong KongChina
| | - Emelia Thiara
- Paediatric Intensive Care UnitNational University HospitalSingapore
| | - Violeta Lopez
- Alice Lee Centre for Nursing StudiesYong Loo Lin School of Medicine, National University of SingaporeSingapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing StudiesYong Loo Lin School of Medicine, National University of SingaporeSingapore
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Sonenblum SE, Sprigle SH. Buttock tissue response to loading in men with spinal cord injury. PLoS One 2018; 13:e0191868. [PMID: 29415014 PMCID: PMC5802854 DOI: 10.1371/journal.pone.0191868] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/13/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE/BACKGROUND Despite the fact that most people with a spinal cord injury who use a wheelchair for mobility are considered at-risk for pressure ulcer (PrU) development, there still exists a spectrum of risk amongst this group. Efforts to differentiate risk level would benefit from clinical tools that can measure or predict the buttocks response to loading. Therefore, the goal of this study was to identify how tissue compliance and blood flow were impacted by clinically-measurable risk factors in young men with SCI. METHODS Blood flow at the ischial tuberosity was measured using laser Doppler flowmetry while the seated buttock was unloaded, and loaded at lower (40-60 mmHg) and high (>200 mmHg) loads. Tissue compliance of the buttock was measured using the Myotonometer while subject were lifted in a Guldmann Net. RESULTS Across 28 participants, blood flow was significantly reduced at high loads, while no consistent, significant changes were found at lower loads. At 40-60 mmHg, blood flow decreased in participants with a pressure ulcer history and lower BMI, but stayed the same or increased in most other participants. The buttock displaced an average of 9.3 mm (2.7 mm) at 4.2 N, which represented 82% (7%) of maximum displacement. BMI was related to the amount of buttock tissue displacement while smoking status explained some of the variation in the percent of max displacement. CONCLUSION Wide variability in tissue compliance and blood flow responses across a relatively homogeneous population indicate that differences in biomechanical risk may provide an explanation for the spectrum of PrU risk among persons with SCI.
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Affiliation(s)
- Sharon Eve Sonenblum
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Stephen H. Sprigle
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- School of Industrial Design, Georgia Institute of Technology, Atlanta, Georgia, United States of America
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Abstract
OBJECTIVE To describe differences in in-seat behavior observed between individuals with a spinal cord injury (SCI) with and without a history of recurrent pressure injuries. DESIGN Cross-sectional cohort study. SETTING General community. PARTICIPANTS Twenty-nine adults more than 2 years post SCI, who used a wheelchair as their primary mobility device and had the ability to independently perform weight shift maneuvers. Participants were grouped according to whether or not they had a history of recurrent pressure injuries (PrIs), with 12 subjects having had two or more pressure injuries in the pelvic area (PrI Group). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Daily time in wheelchair, number of transfers, and frequency of pressure reliefs (full unloading), weight shifts (30% load reduction), and in-seat movements (transient center of pressure movements or unloading). RESULTS The median participant spent 10.3 hours in his wheelchair and performed 16 transfers to or from the wheelchair daily. Pressure reliefs were performed less than once every 3 hours in both groups. Weight shifts were performed significantly more often by the No PrI Group (median (interquartile range) 2.5 (1.0-3.6) per hour) than the PrI Group (1.0 (0.4-1.9), with P = 0.037 and effect size r = 0.39). In-seat movements were performed 46.5 (28.7-76.7) times per hour by the No PrI group and 39.6 (24.3-49.7) times per hour for the PrI group (P = 0.352, effect size r = 0.17). CONCLUSION Weight shifts that can be produced by functional activities and that partially unload the buttocks should be considered as an important addition to individuals' PrI prevention regimen.
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Affiliation(s)
- Sharon E. Sonenblum
- Correspondence to: Sharon Sonenblum, Depart 400, Applied Physiology M/C 0356, 555 14th Street, Atlanta, GA 30332 USA.
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Exploring repositioning movements in sitting with 'at risk' groups using accelerometry and interface pressure mapping technologies. J Tissue Viability 2017; 27:10-15. [PMID: 29268953 DOI: 10.1016/j.jtv.2017.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 10/30/2017] [Accepted: 11/08/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite high quality guidelines underpinning pressure ulcer care (NPUAP/EPUAP/PPPIA, 2014), pressure ulceration still poses a significant financial impact on health care services in treatment and staff costs as well as having a profound effect on the health and quality of life of individuals experiencing them. Repositioning is a key preventative technique recommended by occupational therapists and other health care professionals. The frequency and quality of repositioning movements performed by individuals, however, can be difficult to determine. This paper explores the use of technology in monitoring repositioning movements in sitting. OBJECTIVE To explore the outputs of technologies such as interface pressure mapping systems and accelerometers in enabling the therapist to accurately monitor seated behaviour and enhance practice through targeted interventions to prevent sitting acquired pressure ulceration. METHOD Reviewing the findings of two recent research studies with 'at risk' cohorts (spinal cord injury; elderly orthopaedic), using accelerometry and seated interface pressures, this paper will highlight how useful this technology is in clinical practice to monitor weight shifts and repositioning behaviours. RESULT Both studies illustrated that the majority of individuals did not adhere to the frequency or magnitude of movements currently recommended to redistribute seating interface pressures. When repositioning was performed it was ineffective in reducing seated pressures. CONCLUSION In an era of personalised medicine, technology has an important role to play in providing the service user, caregivers and healthcare staff with important biofeedback information about seated behaviours, particularly those that minimise the risk of developing sitting acquired pressure ulcers. This information can augment occupational therapists' clinical decision-making in maximising active pressure ulcer prevention.
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Affiliation(s)
- Adam J Singer
- From Departments of Emergency Medicine and Vascular Surgery, Stony Brook University, Stony Brook, NY (A.J.S., A.T.); and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami (R.S.K.)
| | - Apostolos Tassiopoulos
- From Departments of Emergency Medicine and Vascular Surgery, Stony Brook University, Stony Brook, NY (A.J.S., A.T.); and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami (R.S.K.)
| | - Robert S Kirsner
- From Departments of Emergency Medicine and Vascular Surgery, Stony Brook University, Stony Brook, NY (A.J.S., A.T.); and the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami (R.S.K.)
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Ünver S, Fındık ÜY, Özkan ZK, Sürücü Ç. Attitudes of surgical nurses towards pressure ulcer prevention. J Tissue Viability 2017; 26:277-281. [PMID: 28967528 DOI: 10.1016/j.jtv.2017.09.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 07/11/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
Abstract
STUDY AIM Nurses play the key role in prevention of pressure ulcers, and negative attitudes of them may affect preventive care strategies. This research aimed to identify surgical nurses' attitudes towards pressure ulcer prevention. MATERIALS AND METHODS A descriptive and cross-sectional study design was used to collect data between March 31-May 16, 2016 on 101 voluntary nurses (66.01% of all nurses) working in surgical units of a university hospital in Turkey. "Attitude towards Pressure Ulcer Prevention Instrument" and "Nurse Information Form" were used to investigate nurses' attitude toward preventing pressure ulcer. Descriptive statistics, Mann-Whitney U test, independent samples t-test, Pearson's chi-squared, and correlation tests were used to analyse the data. RESULTS The mean age of nurses' was 32.0 ± 6.3 years and, the average duration of clinical experience was 72.3 ± 61 months. A total of 54.5% were working in surgical wards and, 40.6% gained additional education about pressure ulcer care. The mean total attitude score was found to be 80.5% (41.8 ± 4.8). Previous education significantly affected the total attitude score of nurses (p < 0.05). CONCLUSION The total scale score showed that surgical nurses had a positive attitude towards pressure ulcer prevention and nurses who had previous education about pressure ulcer care has higher attitude score than who had not. It is recommended that effective in-service education programs be developed at hospitals or that nurses be required to attend courses to help them to improve their pressure ulcer care.
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Affiliation(s)
- Seher Ünver
- Trakya University, Faculty of Health Sciences, Department of Surgical Nursing, Edirne, Turkey.
| | - Ümmü Yıldız Fındık
- Trakya University, Faculty of Health Sciences, Department of Surgical Nursing, Edirne, Turkey.
| | - Zeynep Kızılcık Özkan
- Trakya University, Faculty of Health Sciences, Department of Surgical Nursing, Edirne, Turkey.
| | - Çağla Sürücü
- Trakya University, Faculty of Health Sciences, Department of Nursing, Edirne, Turkey.
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Meaume S, Marty M, Colin D. Prospective observational study of single- or multi-compartment pressure ulcer prevention cushions: PRESCAROH project. J Wound Care 2017; 26:537-544. [DOI: 10.12968/jowc.2017.26.9.537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S. Meaume
- Rothschild Hospital – Geriatric Department and Wound Care Unit, Assistance Publique hôpitaux de Paris, Paris, France
| | - M. Marty
- Nukleus, Clinical Research Department, Paris, France
| | - D. Colin
- Centre de l'Arche, Saint-Saturnin, France
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Efficacy of Monitoring Devices in Support of Prevention of Pressure Injuries: Systematic Review and Meta-analysis. Adv Skin Wound Care 2017; 29:567-574. [PMID: 27846030 DOI: 10.1097/01.asw.0000504579.83707.f6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
GENERAL PURPOSE To present a systematic review of the literature assessing the efficacy of monitoring devices for reducing the risk of developing pressure injuries. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant should be better able to:1. Explain the methodology of the literature review and its results.2. Discuss the scope of the problem and the implications of the research. ABSTRACT OBJECTIVE: To assess the efficacy of monitoring devices for reducing the risk of developing pressure injuries (PIs). DATA SOURCES The authors systematically reviewed the literature by searching PubMed/MEDLINE and CINAHL databases through January 2016. STUDY SELECTION Articles included clinical trials and cohort studies that tested monitoring devices, evaluating PI risk factors on patients in acute and skilled nursing settings. The articles were scored using the Methodological Index for Non-randomized Studies. DATA EXTRACTION Using a standardized extraction form, the authors extracted patient inclusion/exclusion criteria, care setting, key baseline, description of monitoring device and methodology, number of patients included in each group, description of any standard of care, follow-up period, and outcomes. DATA SYNTHESIS Of the identified 1866 publications, 9 met the inclusion criteria. The high-quality studies averaged Methodological Index for Non-randomized Studies scores of 19.4 for clinical trials and 12.2 for observational studies. These studies evaluated monitoring devices that measured interface pressure, subdermal tissue stress, motion, and moisture. Most studies found a statistically significant decrease in PIs; 2 studies were eligible for meta-analysis, demonstrating that use of monitoring devices was associated with an 88% reduction in the risk of developing PIs (Mantel-Haenszel risk ratio, 0.12; 95% confidence interval, 0.04-0.41; I = 0%). CONCLUSIONS Pressure injury monitoring devices are associated with a strong reduction in the risk of developing PIs. These devices provide clinicians and patients with critical information to implement prevention guidelines. Randomized controlled trials would help assess which technologies are most effective at reducing the risk of developing PIs.
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Routhier F, Lettre J, Miller WC, Borisoff JF, Keetch K, Mitchell IM. Data Logger Technologies for Powered Wheelchairs: A Scoping Review. Assist Technol 2017; 31:19-24. [PMID: 28662364 DOI: 10.1080/10400435.2017.1340913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
In recent years, studies increasingly employed data loggers to record the objective behaviors of powered wheelchair users. Of the data logging work reported in the literature, the technologies used offer marked differences in characteristics. In order to identify and describe the extent of published research activity that relies on data logger technologies for powered wheelchairs, we performed a scoping review of the scientific and grey literature. This scoping review, complementary to a previous one related to manual wheelchairs, is part of a process aiming to help further the development and increase the functionality of data loggers with wheelchairs. Five databases were searched: Medline, Compendex, CINAHL, EMBASE, Google Scholar. Sixty papers were retained for analysis. The most frequently used technologies were all installed on the wheelchair: 19.0% were accelerometers, 14.6% were pressure sensors or switches, 13.9% were odometers, 10.9% were global positioning systems, 9.5% were tilt sensors, and 7.3% were force-sensing technologies. The most reported outcomes were pressure-relief activities (17.3%), distance traveled (9.3%), mobility events (8.9%), acceleration (8.5%), and sitting time (6.9%). Future research may be needed to assess the usefulness of different outcomes and to develop methods more appropriate to optimize the practicality of wheelchair data loggers.
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Affiliation(s)
- François Routhier
- a Department of Rehabilitation , Université Laval , Quebec City , QC , Canada.,b Centre for Interdisciplinary Research in Rehabilitation and Social Integration , Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Institut de Réadaptation en Déficience Physique de Québec , Quebec City , QC , Canada
| | - Josiane Lettre
- b Centre for Interdisciplinary Research in Rehabilitation and Social Integration , Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Institut de Réadaptation en Déficience Physique de Québec , Quebec City , QC , Canada
| | - William C Miller
- c Department of Occupational Science and Occupational Therapy, and Rehabilitation Sciences Graduate Program , University of British Columbia , Vancouver , BC , Canada.,d International Collaboration on Repair Discoveries (ICORD) , Vancouver , BC , Canada.,e GF Strong Rehabilitation Research Program and GF Strong Rehabilitation Centre , Vancouver , BC , Canada
| | - Jaimie F Borisoff
- d International Collaboration on Repair Discoveries (ICORD) , Vancouver , BC , Canada.,f Rehabilitation Engineering Design Laboratory , British Columbia Institute of Technology , Burnaby , BC , Canada
| | - Kate Keetch
- c Department of Occupational Science and Occupational Therapy, and Rehabilitation Sciences Graduate Program , University of British Columbia , Vancouver , BC , Canada.,e GF Strong Rehabilitation Research Program and GF Strong Rehabilitation Centre , Vancouver , BC , Canada
| | - Ian M Mitchell
- g Department of Computer Science , University of British Columbia , Vancouver , BC , Canada
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A study of the utility and equivalency of 2 methods of wound measurement: digitized tracing versus digital photography. Adv Skin Wound Care 2016; 28:252-8. [PMID: 25988734 DOI: 10.1097/01.asw.0000465301.37313.57] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine agreement between digitized tracing and digital photography methods in measuring wound area and healing rate, and to compare and contrast the 2 methods on feasibility and utility in patient care and research settings. SETTING Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada. PARTICIPANTS A total of 20 subjects aged 18 years or older with a spinal cord injury and pressure ulcers that were Stage II or higher, and who had received in- or outpatient wound care at the hospital for at least 3 consecutive weeks. METHODS Wound area was measured at weekly intervals. One assessor calculated wound area from a digitized tracing. A second assessor calculated wound area using a wound photograph. Both assessors used Image-J software. The 2 methods were compared for differences in weekly wound area and weekly healing rate. RESULTS Methods were different for wound area (P < .0001), whereas there was no difference between methods in weekly healing rate (P = .9429). CONCLUSIONS The 2 methods are in agreement on the important parameter of healing rate. Both methods are feasible in clinical settings. Wound photography may be more useful than digitized tracings because it simultaneously captures wound appearance.
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Tissue interface pressure and skin integrity in critically ill, mechanically ventilated patients. Intensive Crit Care Nurs 2016; 38:1-9. [PMID: 27836262 DOI: 10.1016/j.iccn.2016.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/29/2016] [Accepted: 07/27/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe tissue interface pressure, time spent above critical pressure levels and the effect on skin integrity at seven anatomical locations. DESIGN, SETTING, PATIENTS Descriptive, longitudinal study in critically ill mechanically ventilated adults, from Surgical Trauma ICU-STICU; Medical Respiratory ICU-MRICU; Neuroscience ICU-NSICU in a Mid-Atlantic urban university medical centre. Subjects were enroled in the study within 24hours of intubation. MEASUREMENTS Tissue interface pressure was measured continuously using the XSENSOR pressure mapping system (XSENSOR Technology Corporation, Calgary, Canada). Skin integrity was observed at all sites, twice daily, using the National Pressure Ulcer Advisory Panel staging system, for the first seven ICU days and at day 10 and 14. RESULTS Of the 132 subjects, 90.9% had no observed changes in skin integrity. Maximum interface pressure was above 32mmHg virtually 100% of the time for the sacrum, left and right trochanter. At the 45mmHg level, the left and right trochanter had the greatest amount of time above this level (greater than 95% of the time), followed by the sacrum, left and right scapula, and the left and right heels. Similarly, at levels above 60mmHg, the same site order applied. For those six subjects with sacral skin integrity changes, maximum pressures were greater than 32mmHg 100% of the time. Four of the six sacral changes were associated with greater amounts of time above both 45mmHg and 60mmHg than the entire sample. CONCLUSIONS Maximum tissue interface pressure was above critical levels for the majority of the documented periods, especially in the sacrum, although few changes in skin integrity were documented. Time spent above critical levels for mean pressures were considerably less compared to maximum pressures. Maximum pressures may have reflected pressure spikes, but the large amount of time above the critical pressure levels remains substantial.
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Orthotic-Style Off-Loading Wheelchair Seat Cushion Reduces Interface Pressure Under Ischial Tuberosities and Sacrococcygeal Regions. Arch Phys Med Rehabil 2016; 97:1872-1879. [DOI: 10.1016/j.apmr.2016.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 11/22/2022]
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Dowling AV, Eberly V, Maneekobkunwong S, Mulroy SJ, Requejo PS, Gwin JT. Telehealth monitor to measure physical activity and pressure relief maneuver performance in wheelchair users. Assist Technol 2016; 29:202-209. [PMID: 27687753 DOI: 10.1080/10400435.2016.1220993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
This study demonstrated the feasibility of a device for monitoring pressure relief maneuvers and physical activity for wheelchair users. The device counts the number of wheel pushes based on wheelchair acceleration and measures pressure relief maneuvers using a seat sensor consisting of three force sensing resistors (FSRs). To establish the feasibility of the seat sensor for the detection of pressure relief maneuvers, 10 wheelchair users and 10 non-disabled controls completed a series of wheelchair depression raises, forward trunk leans, and lateral trunk leans. The seat sensor was placed underneath the user's seat cushion. To establish the feasibility of wheel push counting, 10 full-time wheelchair users navigated a flat 50-m outdoor track and a 100-m outdoor obstacle course during self-propulsion (e.g., wheel pushes) and during assisted-propulsion (e.g., no wheel pushes). Of the 240 performed pressure relief, 225 were properly classified by the seat sensor (accuracy: 94%, sensitivity: 96%, specificity: 80%). Sensitivity was highest for depression raises (98%) and lowest for front lean maneuvers (80%). The wheelchair activity monitor measured 2,112 pushes during the self-propulsion trials compared to 2,162 pushes measured with the instrumented push-rim (97.7%). During assisted-propulsion trials, there were 477 incorrectly identified pushes (8.0 per trial).
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Affiliation(s)
| | - Valerie Eberly
- b Pathokinesiology Laboratory , Rancho Los Amigos National Rehabilitation Center , Downey , California , USA
| | - Somboon Maneekobkunwong
- b Pathokinesiology Laboratory , Rancho Los Amigos National Rehabilitation Center , Downey , California , USA
| | - Sara J Mulroy
- b Pathokinesiology Laboratory , Rancho Los Amigos National Rehabilitation Center , Downey , California , USA
| | - Philip S Requejo
- b Pathokinesiology Laboratory , Rancho Los Amigos National Rehabilitation Center , Downey , California , USA
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Rodrigues AM, Ferreira PL, Ferré-Grau C. Providing informal home care for pressure ulcer patients: how it affects carers' quality of life and burden. J Clin Nurs 2016; 25:3026-35. [PMID: 27577533 DOI: 10.1111/jocn.13356] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 12/31/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the quality of life of informal caregivers of patients with pressure ulcer; to assess their levels of burden; to analyse the variables influencing both their quality of life and burden. BACKGROUND Informal caregivers of pressure ulcer patients, besides coping with the natural dependency of these patients, deal with the specificity of caring these types of wounds. This situation has an impact on not only the quality of life and burden felt by informal caregivers but also on individual and familiar dynamics. DESIGN Descriptive and correlational study. METHODS This study focused on 145 informal caregivers providing home care. Measurement instruments were: SF-36v2 and the Burden Interview Scale. Descriptive analysis of the quantitative variables was carried out according to measures of central tendency, and the qualitative variables were described using absolute and relative frequencies. The relationships or associations between variables were explored through correlational analysis and, whenever the data allowed, multivariate techniques were used. RESULTS AND DISCUSSION Informal caregivers showed low levels of quality of life and, most of them, significant burden. Quality of life decreased with overload, with the increasing number of pressure ulcer and with less experience of informal caregivers, with lack of financial remuneration, with unemployment, with patient positioning and with the direct care of the wound. The burden increased with the number of pressure ulcer in each patient and with the lack of financial remuneration. CONCLUSION These informal caregivers have low quality of life and are overburdened. Both situations are positively and negatively influenced by factors related to the pressure ulcer and to the patients' sociodemographic data. RELEVANCE TO CLINICAL PRACTICE The results of this study allow more effective monitoring by health professionals of levels of burden and quality of life encountered in pressure ulcer informal caregivers, as well as direct interventions to inhibit the factors inducing burden and enhance those that improve quality of life.
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Affiliation(s)
- Alexandre M Rodrigues
- School of Health, University of Aveiro, Aveiro, Portugal. .,CEISUC - Centre for Health Studies and Research of the University of Coimbra, Coimbra, Portugal.
| | - Pedro L Ferreira
- CEISUC - Centre for Health Studies and Research of the University of Coimbra, Coimbra, Portugal.,Faculty of Economics, University of Coimbra, Coimbra, Portugal
| | - Carmen Ferré-Grau
- Nursing Department, University of Roviri i Virgili, Tarragona, Spain
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Evaluation of physiological risk factors, oxidant-antioxidant imbalance, proteolytic and genetic variations of matrix metalloproteinase-9 in patients with pressure ulcer. Sci Rep 2016; 6:29371. [PMID: 27405842 PMCID: PMC4942564 DOI: 10.1038/srep29371] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 06/20/2016] [Indexed: 12/17/2022] Open
Abstract
Pressure ulcer (PU) remains a common worldwide problem in all health care settings, it is synonymous with suffering. PU is a complex disease that is dependent on a number of interrelated factors. It involves multiple mechanisms such as physiological risk factors, chronic inflammation, oxidant–antioxidant imbalance and proteolytic attack on extracellular matrix by matrix metalloproteinases (MMP). Therefore, we propose that these wounds lead to molecular variations that can be detected by assessing biomarkers. In this study, we aimed to evaluate the major clinical elements and biological scars in Tunisian patients suffering from PU. Consistently, non-healing wound remains a challenging clinical problem. The complex challenges of the wound environment, involving nutrient deficiencies, bacterial infection, as well as the critical role played by inflammatory cells, should be considered because of their negative impact on wound healing. In addition, an imbalance between pro-oxidants and antioxidant systems seems to be more aggravated in patients with PU compared to healthy subjects. Of interest, this study provides further evidence to support a core role of the biological activity of MMP-9 in the pathogenesis of PU and indicates that the MMP9-1562 C/T (rs 3918242) functional polymorphism is associated with protection against this disease.
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Tung JY, Stead B, Mann W, Ba'Pham, Popovic MR. Assistive technologies for self-managed pressure ulcer prevention in spinal cord injury: a scoping review. ACTA ACUST UNITED AC 2016; 52:131-46. [PMID: 26237111 DOI: 10.1682/jrrd.2014.02.0064] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 01/26/2015] [Indexed: 11/05/2022]
Abstract
Pressure ulcers (PUs) in individuals with spinal cord injury (SCI) present a persistent and costly problem. Continuing effort in developing new technologies that support self-managed care is an important prevention strategy. Specifically, the aims of this scoping review are to review the key concepts and factors related to self-managed prevention of PUs in individuals with SCI and appraise the technologies available to assist patients in self-management of PU prevention practices. There is broad consensus that sustaining long-term adherence to prevention regimens is a major concern. Recent literature highlights the interactions between behavioral and physiological risk factors. We identify four technology categories that support self-management: computer-based educational technologies demonstrated improved short-term gains in knowledge (2 studies), interface pressure mapping technologies demonstrated improved adherence to pressure-relief schedules up to 3 mo (5 studies), electrical stimulation confirmed improvements in tissue tolerance after 8 wk of training (3 studies), and telemedicine programs demonstrated improvements in independence and reduced hospital visits over 6 mo (2 studies). Overall, self-management technologies demonstrated low-to-moderate effectiveness in addressing a subset of risk factors. However, the effectiveness of technologies in preventing PUs is limited due to a lack of incidence reporting. In light of the key findings, we recommend developing integrated technologies that address multiple risk factors.
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Affiliation(s)
- James Y Tung
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Canada
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Wininger M, Crane BA. Product limit estimation for capturing of pressure distribution dynamics. Med Eng Phys 2016; 38:427-32. [PMID: 27021374 DOI: 10.1016/j.medengphy.2016.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 12/10/2015] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
Measurement of contact pressures at the wheelchair-seating interface is a critically important approach for laboratory research and clinical application in monitoring risk for pressure ulceration. As yet, measures obtained from pressure mapping are static in nature: there is no accounting for changes in pressure distribution over time, despite the well-known interaction between time and pressure in risk estimation. Here, we introduce the first dynamic analysis for distribution of pressure data, based on the Kaplan-Meier (KM) Product Limit Estimator (PLE) a ubiquitous tool encountered in clinical trials and survival analysis. In this approach, the pressure array-over-time data set is sub-sampled two frames at a time (random pairing), and their similarity of pressure distribution is quantified via a correlation coefficient. A large number (here: 100) of these frame pairs is then sorted into descending order of correlation value, and visualized as a KM curve; we build confidence limits via a bootstrap computed over 1000 replications. PLEs and the KM have robust statistical support and extensive development: the opportunities for extended application are substantial. We propose that the KM-PLE in particular, and dynamic analysis in general, may provide key leverage on future development of seating technology, and valuable new insight into extant datasets.
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Affiliation(s)
- Michael Wininger
- University of Hartford, Department of Rehabilitation Sciences, West Hartford, CT 06117, United States; Veterans Affairs Cooperative Studies Program, VA Connecticut Healthcare System, West Haven, CT 06150, United States; Yale School of Public Health, Department of Biostatistics, New Haven, CT 06520, United States
| | - Barbara A Crane
- University of Hartford, Department of Rehabilitation Sciences, West Hartford, CT 06117, United States.
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Worsley PR, Clarkson P, Bader DL, Schoonhoven L. Identifying barriers and facilitators to participation in pressure ulcer prevention in allied healthcare professionals: a mixed methods evaluation. Physiotherapy 2016; 103:304-310. [PMID: 27033782 DOI: 10.1016/j.physio.2016.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 02/16/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the barriers and facilitators for allied health professional's participation in pressure ulcer prevention. DESIGN Mixed method cohort study. SETTING Single centre study in an acute university hospital trust. PARTICIPANTS Five physiotherapists and four occupational therapists were recruited from the hospital trust. Therapists had been working in the National Health Service (NHS) for a minimum of one year. MAIN OUTCOME MEASURES Therapist views and experiences were collated using an audio recorded focus group. This recording was analysed using constant comparison analysis. Secondary outcomes included assessment of attitudes and knowledge of pressure ulcer prevention using questionnaires. RESULTS Key themes surrounding barriers to participation in pressure ulcer prevention included resources (staffing and equipment), education and professional boundaries. Fewer facilitators were described, with new training opportunities and communication being highlighted. Results from the questionnaires showed the therapists had a positive attitude towards pressure ulcer prevention with a median score of 81% (range 50 to 83%). However, there were gaps in knowledge with a median score of 69% (range 50 to 77%). CONCLUSIONS The therapist reported several barriers to pressure ulcer prevention and few facilitators. The primary barriers were resources, equipment and education. Attitudes and knowledge in AHPs were comparable to data previously reported from experienced nursing staff.
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Affiliation(s)
- Peter R Worsley
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
| | - Paul Clarkson
- Faculty of Health Sciences, University of Southampton, Southampton, UK; Southern Health NHS Foundation Trust, Tatchbury Mount, Calmore, Southampton, UK
| | - Dan L Bader
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Lisette Schoonhoven
- Faculty of Health Sciences, University of Southampton, Southampton, UK; NIHR CLAHRC Wessex, UK
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Effects of different heel angles in sleep mode on heel interface pressure in the elderly. Clin Biomech (Bristol, Avon) 2016; 32:229-35. [PMID: 26651476 DOI: 10.1016/j.clinbiomech.2015.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/04/2015] [Accepted: 11/17/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The heels are one of the most common sites of pressure ulcers, and the incidence rate in the elderly aged 70 years or older is high. Although there is literature on heel interface pressure, the heel interface pressure of the elderly in different postures has not yet been explored, which will be investigated in this study, as well as the effects of different foot positions. Their skin conditions will also be examined. METHODS Twenty-five females and twenty-six males, 70 years old or older, are evaluated while lying down, with only their naked foot in its natural position on a mattress, as well as placed on a standard or pressure-relieving mattress in different positions. The moisture, sebum content, and elasticity of the skin of the heel are tested. FINDINGS The heel of most of the participants is positioned at a 60°-69° or 90°-99° angle to the support surface. The heel interface pressure is the greatest when the foot is upright. The age, weight, and body mass index have no significant impacts. The moisture and sebum content are extremely low while elasticity is normal. INTERPRETATION The relaxed position of the foot is in neutral external rotation and upright positions. A greater amount of pressure is experienced when the foot is upright. The pressure-relieving mattress is more effective for reducing heel pressure but may not apply to all cases. Finally, the skin of the heel is dry and lacks sebum, which implies greater risk of developing heel sores.
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Sonenblum SE, Sprigle SH, Martin JS. Everyday sitting behavior of full-time wheelchair users. ACTA ACUST UNITED AC 2016; 53:585-598. [DOI: 10.1682/jrrd.2015.07.0130] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/02/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Sharon E. Sonenblum
- Rehabilitation Engineering and Applied Research Laboratory, Georgia Institute of Technology, Atlanta, GA
| | - Stephen H. Sprigle
- Rehabilitation Engineering and Applied Research Laboratory, Georgia Institute of Technology, Atlanta, GA
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Bérubé M, Albert M, Chauny JM, Contandriopoulos D, DuSablon A, Lacroix S, Gagné A, Laflamme É, Boutin N, Delisle S, Pauzé AM, MacThiong JM. Development of theory-based knowledge translation interventions to facilitate the implementation of evidence-based guidelines on the early management of adults with traumatic spinal cord injury. J Eval Clin Pract 2015; 21:1157-68. [PMID: 25832735 DOI: 10.1111/jep.12342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2015] [Indexed: 12/12/2022]
Abstract
RATIONALE Optimal, early management following a spinal cord injury (SCI) can limit individuals' disabilities and costs related to their care. Several knowledge syntheses were recently published to guide health care professionals with regard to early interventions in SCI patients. However, no knowledge translation (KT) intervention, selected according to a behaviour change theory, has been proposed to facilitate the use of SCI guidelines in an acute care setting. OBJECTIVES To develop theory-informed KT interventions to promote the application of evidence-based recommendations on the acute care management of SCI patients. METHODS The first four phases of the knowledge-to-action model were used to establish the study design. Knowledge selection was based on the Grading of Recommendations Assessment, Development and Evaluation system. Knowledge adaptation to the local context was sourced from the ADAPTE process. The theoretical domains framework oriented the selection and development of the interventions based on an assessment of barriers and enablers to knowledge application. RESULTS Twenty-nine recommendations were chosen and operationalized in measurable clinical indicators. Barriers related to knowledge, skills, perceived capacities, beliefs about consequences, social influences, and the environmental context and resources theoretical domains were identified. The mapping of behaviour change techniques associated with those barriers led to the development of an online educational curriculum, interdisciplinary clinical pathways as well as policies and procedures. CONCLUSIONS This research project allowed us developing KT interventions according to a thorough behavioural change methodology. Exposure to the generated interventions will support health care professionals in providing the best care to SCI patients.
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Affiliation(s)
- Mélanie Bérubé
- Orthopaedics and Trauma, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,McGill University, Montreal, Quebec, Canada
| | - Martin Albert
- Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Marc Chauny
- Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Montreal, Quebec, Canada
| | | | - Anne DuSablon
- Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Sébastien Lacroix
- Université de Montréal, Montreal, Quebec, Canada.,Hôtel Dieu de St-Jérôme, Montreal, Quebec, Canada
| | - Annick Gagné
- Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Élise Laflamme
- Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Nathalie Boutin
- Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | | | | | - Jean-Marc MacThiong
- Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Montreal, Quebec, Canada
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Proxy study on minimizing risk of sacral pressure ulcers while complying with ventilator-associated pneumonia risk reduction guidelines. Adv Skin Wound Care 2015; 28:541-50. [PMID: 26562200 DOI: 10.1097/01.asw.0000471877.19459.85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bed positioning poses a subtle, yet important, tradeoff in the competing needs of hospitalized patients, particularly those susceptible to lower respiratory tract infections and/or pressure ulcers. Although it is widely held that a minimum 30° incline is necessary to mitigate risk of ventilator-acquired pneumonia, it is unclear what effect semirecumbent positioning has on the risk of pressure ulcerations. The authors test several hypotheses with the objective of elucidating the relationship between bed incline, posture, and incline, pursuant to a more evidence-based recommendation for practice in clinical care. To this end, interfacial pressures from 40 healthy subjects were analyzed following observation in both supine and sidelying positions, at shallow (30°) and moderate (45°) bed-angle incline. Summarily, the authors report that supine postures reduce pressure signatures associated with pressure ulceration versus sidelying position: 15% increase area of contact (P = 1.3×10), and 17% decrease in ratio of peak to average pressure (P = 3.1×10). Within supine posture, the authors found significant increases in 4 measures of local pressure, including average pressure (10.4% decrease, P = .005) and coefficient of pressure variation (22.1%, P = 2.2×10) at moderate incline. The authors conclude that supine bed positionings at moderate incline appear to reduce predictors of pressure ulceration.
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