Geyer M J, Brienza D M, Karg P, Trefler E, Kelsey S
University of Pittsburgh, Department of Rehabilitation Science and Technology, PA, USA.
Adv Skin Wound Care. 2001 May-Jun;14(3):120-9; quiz 131-2. doi: 10.1097/00129334-200105000-00008.
To determine if the use of pressure-reducing wheelchair cushions for elderly nursing home resident wheelchair users who are at high risk for developing sitting-acquired pressure ulcers would result in a lower incidence rate of pressure ulcers, a greater number of days until ulceration, and lower peak interface pressures compared with the use of convoluted foam cushions over a 12-month period. To determine the feasibility of conducting a subsequent full-scale definitive trial to evaluate the use of pressure-reducing seat cushions for elderly nursing home resident wheelchair users.
Randomized control trial
2200-bed skilled nursing facilities (1 suburban and 1 urban academic medical center)
32 male and female at-risk nursing home residents who were wheelchair users > or = 65 years of age. Participants had Braden Scale scores < or = 18, Braden Activity and Mobilitysubscale scores < or = 5, no sitting surface pressure ulcers, and a daily wheelchair sitting tolerance of more than 6 hours. All met criteria for using the ETAC Twin wheelchair.
Seating evaluation with pressure-mapping and subsequent seating prescription. Subjects were assigned to either a foam (n=17) or pressure-reducing cushion (n=15) group and weekly assessments of skin and pressure ulcer risk were made.
Incidence of pressure ulcers, days to ulceration, and peak interface pressure.
At a 95% confidence interval, a 2-tailed analysis showed no differences between the FOAM and pressure-reducing cushion groups for pressure ulcer incidence, total days to pressure ulcer, or initial peak interface pressure. Pressure-reducing cushions were more effective in preventing sitting-acquired (ischial) pressure ulcers (P<.005). Higher interface pressures were associated with a higher incidence of pressure ulcers (P<.001).
A definitive randomized control multicenter cushion trial is feasible with a sample size of 50 to 100 per study group. In the definitive trial, the definition of sitting-acquired pressure ulcers should be limited to lesions occurring over the ischial tuberosities.
确定对于有发生坐姿性压疮高风险的老年疗养院轮椅使用者，使用减压轮椅坐垫与使用波浪形泡沫坐垫相比，在12个月期间是否会导致更低的压疮发病率、更长的至溃疡形成天数以及更低的峰值界面压力。确定开展后续全面确定性试验以评估老年疗养院轮椅使用者使用减压坐垫的可行性。
随机对照试验
拥有2200张床位的专业护理机构（1家郊区和1家城市学术医疗中心）
32名年龄≥65岁、有风险的男性和女性疗养院居民，均为轮椅使用者。参与者的Braden量表评分≤18，Braden活动与移动性子量表评分≤5，无坐姿表面压疮，且每日轮椅坐姿耐受时间超过6小时。所有参与者均符合使用ETAC Twin轮椅的标准。
通过压力映射进行座位评估并随后开具座位处方。将受试者分为泡沫坐垫组（n = 17）或减压坐垫组（n = 15），并每周对皮肤和压疮风险进行评估。
压疮发病率、至溃疡形成天数和峰值界面压力。
在95%置信区间，双尾分析显示泡沫坐垫组和减压坐垫组在压疮发病率、至压疮总天数或初始峰值界面压力方面无差异。减压坐垫在预防坐姿性（坐骨结节处）压疮方面更有效（P <.005）。更高的界面压力与更高的压疮发病率相关（P <.001）。
每个研究组样本量为50至100的确定性随机对照多中心坐垫试验是可行的。在确定性试验中，坐姿性压疮的定义应限于发生在坐骨结节处的损伤。
