Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia.
School of Health, Medical and Applied Sciences, CQ University, Rockhampton, Queensland, Australia.
Aust Occup Ther J. 2024 Aug;71(4):612-626. doi: 10.1111/1440-1630.12932. Epub 2024 Jan 31.
Pressure injuries are a preventable yet highly prevalent health concern. Wheelchair cushion prescription can have significant implications for wheelchair users' risk of pressure injury development, which can impact functional abilities and quality of life. The efficacy of a wheelchair cushion to redistribute pressure has been well-researched, but the efficacy to manage the microclimate is less clear, particularly in warm-hot environments. The aim of this study was to systematically review studies examining the effect of wheelchair cushions on temperature, moisture and thermal perception to determine which cushions are superior to improve these responses.
A systematic review with meta-analyses of randomised cross-over and randomised control trials of wheelchair cushion interventions on measures of temperature, moisture, and thermal perception was conducted.
Eight studies were identified that met the eligibility criteria and six meta-analyses were conducted. Pooled analyses identified a significantly lower temperature on foam-gel cushions compared to air cushions (MD = 0.80, 95% CI: 0.31, 1.29; p = 0.002) and a significantly lower temperature on foam-gel cushions compared to foam cushions (SMD = 0.76, 95%CI; 0.45, 1.06; p < 0.00001). Pooled analyses also demonstrated significantly lower relative humidity (i.e., moisture) on foam cushions compared to foam-gel cushions (p = 0.02). Differences in thermal perception were inconclusive due to limited data found.
It is clear that not one cushion is ideal in managing all aspects of microclimate, as foam-gel cushions were the superior cushion to manage temperature and foam cushions were the superior cushion to manage moisture. This article provides occupational therapists and other health professionals with evidence-based information to assist with wheelchair cushion prescription that minimises the temperature and moisture accumulation, and associated risk of pressure injury for wheelchair users.
压力性损伤是一种可预防但普遍存在的健康问题。轮椅坐垫的处方可能对轮椅使用者发生压力性损伤的风险有重大影响，进而影响其功能能力和生活质量。人们已经充分研究了轮椅坐垫在重新分配压力方面的功效，但对于管理微气候的功效则了解较少，特别是在温暖或炎热的环境中。本研究旨在系统回顾评估轮椅坐垫对温度、湿度和热感觉影响的研究，以确定哪些坐垫在改善这些反应方面更具优势。
对评估轮椅坐垫干预措施对温度、湿度和热感觉的随机交叉和随机对照试验进行了系统回顾和荟萃分析。
确定了 8 项符合入选标准的研究，并进行了 6 项荟萃分析。汇总分析表明，与空气垫相比，泡沫凝胶垫的温度显著降低（MD=0.80，95%CI：0.31，1.29；p=0.002），与泡沫垫相比，泡沫凝胶垫的温度显著降低（SMD=0.76，95%CI：0.45，1.06；p<0.00001）。汇总分析还表明，与泡沫凝胶垫相比，泡沫垫的相对湿度（即湿度）显著降低（p=0.02）。由于发现的数据有限，热感觉的差异尚无定论。
很明显，没有一种坐垫在管理微气候的所有方面都是理想的，因为泡沫凝胶垫在管理温度方面更具优势，而泡沫垫在管理湿度方面更具优势。本文为职业治疗师和其他健康专业人员提供了循证信息，以协助进行轮椅坐垫处方，从而最大限度地减少轮椅使用者的温度和湿度积累，以及相关的压力性损伤风险。
