Exploring repositioning movements in sitting with 'at risk' groups using accelerometry and interface pressure mapping technologies

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

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.

A systematic review of movement monitoring devices to aid the prediction of pressure ulcers in at-risk adults

The present study sought to explore the impact of movement monitoring devices on risk prediction and prevention of pressure ulcers (PU) among adults. Using systematic review methodology, we included original research studies using a prospective design, written in English, assessing adult patients' movement in bed, using a movement monitoring device. The search was conducted in March 2021, using PubMed, CINAHL, Scopus, Cochrane, and EMBASE databases, and returned 1537 records, of which 25 met the inclusion criteria. Data were extracted using a pre-designed extraction tool and quality appraisal was undertaken using the evidence-based librarianship (EBL). In total, 19 different movement monitoring devices were used in the studies, using a range of physical sensing principles. The studies focused on quantifying the number and types of movements. In four studies the authors compared the monitoring system with PU risk assessment tools, with a variety of high and low correlations observed. Four studies compared the relationship between movement magnitude and frequency and the development of PUs, with variability in results also identified. Two of these studies showed, as expected, that those who made less movements developed more PU; however, the two studies also unexpectedly found that PUs occurred in both low movers and high movers. In the final two studies, the authors focused on the concordance with recommended repositioning based on the results of the monitoring device. Overall, concordance with repositioning increased with the use of a monitoring device. The synthesis of the literature surrounding bed monitoring technologies for PU risk prediction showed that a range of physical sensors can be used to detect the frequency of movement. Clinical studies showed some correlation between parameters of movement and PU risk/incidence, although the heterogeneity of approaches limits generalisable recommendations.

Visualization of user interactions with a pressure mapping mobile application for wheelchair users at risk for pressure injuries

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.

Frequency and risk factors of pressure injuries in clinical settings of affiliated to Tabriz University of Medical Sciences

AIM

Pressure injuries are considered a common and costly problem in the care of patients. Prevention and identification of risk factors for pressure injuries are very important due to the high cost of treatment and the adverse consequences of pressure injuries. This study aimed to assess the prevalence of pressure injuries and its risk factors in clinical settings of affiliated to Tabriz University of Medical Sciences.

DESIGN

A descriptive-analytical study.

METHODS

This study was performed on 200 patients who were selected by random sampling. The data collection tool was a 3-part questionnaire. Data were analysed using a t test, chi-square, Fisher's exact test and logistic regression in SPSS v. 24.

RESULTS

The mean age of the participants was 51.93 (SD 14.99) years. The rate of pressure injuries in this study was 19.5%. The most susceptible area for pressure injuries were sacral (35.89%) and gluteal (20.51%), respectively. The pressure injuries was significantly associated with Braden's criteria, age, disease diagnosis and length of hospital stay (p < .05). But there was no statistically significant difference between sex and incidence of pressure injuries (p > .05).

Biomechanical monitoring and machine learning for the detection of lying postures

BACKGROUND

Pressure mapping technology has been adapted to monitor over prolonged periods to evaluate pressure ulcer risk in individuals during extended lying postures. However, temporal pressure distribution signals are not currently used to identify posture or mobility. The present study was designed to examine the potential of an automated approach for the detection of a range of static lying postures and corresponding transitions between postures.

METHODS

Healthy subjects (n = 19) adopted a range of sagittal and lateral lying postures. Parameters reflecting both the interactions at the support surface and body movements were continuously monitored. Subsequently, the derivative of each signal was examined to identify transitions between postures. Three machine learning algorithms, namely Naïve-Bayes, k-Nearest Neighbors and Support Vector Machine classifiers, were assessed to predict a range of static postures, established with a training model (n = 9) and validated with new input from test data (n = 10).

FINDINGS

Results showed that the derivative signals provided a means to detect transitions between postures, with actimetry providing the most distinct signal perturbations. The accuracy in predicting the range of postures from new test data ranged between 82%-100%, 70%-98% and 69%-100% for Naïve-Bayes, k-Nearest Neighbors and Support Vector Machine classifiers, respectively.

INTERPRETATION

The present study demonstrated that detection of both static postures and their corresponding transitions was achieved by combining machine learning algorithms with robust parameters from two monitoring systems. This approach has the potential to provide reliable indicators of posture and mobility, to support personalised pressure ulcer prevention strategies.

Review of Measuring Microenvironmental Changes at the Body-Seat Interface and the Relationship between Object Measurement and Subjective Evaluation

Being seated has increasingly pervaded both working and leisure lifestyles, with development of more comfortable seating surfaces dependent on feedback from subjective questionnaires and design aesthetics. As a consequence, research has become focused on how to objectively resolve factors that might underpin comfort and discomfort. This review summarizes objective methods of measuring the microenvironmental changes at the body–seat interface and examines the relationship between objective measurement and subjective sensation. From the perspective of physical parameters, pressure detection accounted for nearly two thirds (37/54) of the publications, followed by microclimatic information (temperature and relative humidity: 18/54): it is to be noted that one article included both microclimate and pressure measurements and was placed into both categories. In fact, accumulated temperature and relative humidity at the body–seat interface have similarly negative effects on prolonged sitting to that of unrelieved pressure. Another interesting finding was the correlation between objective measurement and subjective evaluation; however, the validity of this may be called into question because of the differences in experiment design between studies.

The effectiveness of curvilinear supine position on the incidence of pressure injuries and interface pressure among surgical patients

BACKGROUND

Intraoperative pressure injury is still a major problem of perioperative nursing. Reducing the peak interface pressure is a valid clinical intervention for reducing the incidence of intraoperative pressure injuries. However, studies of repositioning and pressure-redistributing for surgical patients are still lacking. In this context we aimed to evaluate the effect of a curvilinear supine position on incidence of pressure injury with surgical patients in a hospital setting.

METHODS

This was a prospective, randomized, controlled study, carried out from May to December 2016, included 104 surgical patients from a university hospital in China (experimental group, n = 52; control group, n = 52). Incidence of pressure injury, interface pressure, comfort and satisfaction scores from surgeons, anesthesiologists, OR nurses were recorded. Mann-Whitney U Chi-square test was used for difference of pressure injury's incidence and mixed linear model was used for interface pressure.

RESULTS

Overall the intervention group had significant fewer intraoperative pressure injuries than the control group (0 patients [0%] vs. 9 patients [17.65%], p = 0.002). Compared with control group, the experimental group had significantly lower interface pressures in the sacrum and heel regions (F = 23.81, p < 0.001; F = 60.71, p < 0.001). The subjects felt comfortable in two groups were 40(80%) vs. 3(5.88%) (experimental group vs. control group), respectively (p < 0.001).

CONCLUSIONS

Curvilinear supine position could significantly decrease the incidence of perioperative pressure injuries in surgical patients with surgery duration more than three hours. Considering these results, we recommend that curvilinear supine position use as effective interventions to inform perioperative care delivery, reducing perioperative pressure injuries. These findings may serve to guide the application of pressure redistribution in the surgical positioning of patients during prolonged surgery.