Some people move it, move it… for pressure injury prevention

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.

Keywords:

• Wheelchairs
• Pressure ulcer
• Pressure injury
• Spinal cord injuries
• Movement
• Monitoring

ORCID

Sharon E. Sonenblum http://orcid.org/0000-0001-9747-5683

Stephen H. Sprigle http://orcid.org/0000-0003-0462-0138

Acknowledgements

The authors would like to acknowledge Kevin Caves at Duke University and the Durham VA and Chris Maurer, David Kreutz, and Jennith Bernstein at Shepherd Center, and Teddy Lisette Vonk, MS, for their efforts with participant recruitment and data collection. We would also like to acknowledge Ricardo Lopez, MS for his work developing the data collection hardware, James Martin and Dr. Rui Dai for their work on the data analysis method

Additional information

Funding

This work was completed as part of the Mobility RERC, which is funded by the National Institute on Disability, Independent Living, and Rehabilitation Research [grant number H133E080003]. Support for this study was also provided through the US Department of Defense [grant number W81XWH-13-1-0387].