Effects of therapeutic positioning on vital parameters in patients with central neurological disorders: a randomised controlled trial

Experience-based Modifications of the Bed Band ReAlised through Co-dEsign (EMBRACE)

BACKGROUND

Upper body limitations are a common disability in neurological conditions including stroke and multiple sclerosis. Care of patients with upper body limitations while in bed involves positioning techniques to maximise comfort and independence. The Bed Band is a nurse-led innovation to support people with limited mobility to maintain a comfortable position in bed, thereby promoting comfort and independence with activities of daily living.

AIM

To co-design and implement adaptations to the Bed Band prototype with recommendations for user instructions towards enhanced product design and future development.

METHODS

A co-design approach involving collaboration between academic and industry partners. Expert stakeholders provided feedback on the Bed Band via an online focus group before healthy volunteers tested the product in a healthcare simulation suite. Data were thematically analysed and findings sense checked by expert stakeholders who then prioritised adaptations to the Bed Band using a modified Delphi technique.

RESULTS

Three themes resulted from the analysis: (1) reaction to the Bed Band; (2) potential risks and mitigation; and (3) product adaptations. Simplicity was a strength of the innovation which easily enabled positional support. Adaptations to the Bed Band informed the development of an enhanced prototype for testing in future studies.

CONCLUSION

Co-design of the Bed Band prototype involving experts and healthy volunteers enabled early identification of potential risks with recommendations to mitigate them and priority adaptations. Further studies are required in hospital patients and community populations with upper mobility issues to determine the efficacy of the Bed Band and optimal duration of use.

Factors Facilitating and Hindering the Use of Newly Acquired Positioning Skills in Clinical Practice: A Longitudinal Survey

Background

After learning new skills, healthcare professionals do not always apply them in practice, despite being motivated. This may be referred to as an intention-behavior gap. One example is the positioning of immobilized and disabled patients in hospitals, nursing homes, or neurorehabilitation clinics. Positioning is crucial to prevent complications such as pressure sores, pneumonia, and deep vein thrombosis. However, it is often not carried out optimally even when professionals have completed education programs. The LiN-method is a positioning procedure involving a special focus on aligning and stabilizing body parts, which has been shown to have advantages over conventional positioning. We assess which factors may facilitate or hinder the use of LiN in clinical practice after participants complete training.

Methods

A longitudinal survey with 101 LiN-course participants was conducted in Germany. Each participant completed a questionnaire directly after the course and 12 weeks later, including a report of the frequency of use in practice. They also completed a questionnaire which surveyed 23 aspects that might facilitate or hinder use of the new skills, covering the workplace, socio-collegial factors, motivation, self-confidence, and mindset.

Results

Most assessed aspects were associated with LiN-use, with the highest correlations found for confidence with the method, perceived ease of application, sufficient time, assessing one's skills as sufficient, remembering the relevant steps, and a work environment open to advanced therapeutic concepts. To reduce data complexity, the questionnaire was subjected to a factor analysis, revealing six factors. A regression analysis showed that four factors predicted use 12 weeks after course completion, in the following order of importance: (1) subjective aspects/confidence, (2) access to materials, (3) work context, and (4) competent support in the workplace.

Conclusion

Numerous aspects are associated with the use of recently acquired clinical or nursing skills, such as LiN. Many of these can be improved by appropriately setting up the workplace. The aspects most associated with use, however, are confidence with the method and self-perceived competence of healthcare professionals. While causality still needs to be demonstrated, this suggests that education programs should support participants in developing confidence and foster a mindset of continuous learning.

Support pressure distribution for positioning in neutral versus conventional positioning in the prevention of decubitus ulcers: a pilot study in healthy participants

Background

Decubitus ulcers are associated with a burden for the patients and cause enormous costs. One of the reasons for the development of decubitus is prolonged exposure to pressure. The aim of this pilot study was to examine the pressure distribution of healthy individuals either positioned in Positioning in Neutral (LiN) or conventional positioning (CON).

Methods

Four healthy participants were positioned in a supine, 30° degree side lying and 90° side lying position both in LiN and CON. A thousand pressure sensors in a mattress enabled a visual presentation of low, medium and high pressure on a screen. This presentation was processed by Photoshop in order to count the pixels representing the total support pressure surface and the pressure intensity.

Results

LiN showed, on average, a smaller surface with measurable pressure compared to CON (46,293 versus 64,090 pixels). The areas of medium pressure were comparable. Mean areas of low and high pressure were both smaller in LiN as compared to CON (low: 8315 versus 22,790 pixels; high: 3744 versus 7277 pixels).

Conclusion

The results of this pilot study indicate that LiN is suitable for pressure sore prophylaxis because LiN showed less support surface and less maximum pressure as compared to CON.