A Randomized Clinical Trial of Wheeled Mobility for Pressure Injury Prevention and Better Function

J Am Geriatr Soc. 2018 Sep;66(9):1752-1759. doi: 10.1111/jgs.15495. Epub 2018 Aug 10.

Abstract

Objectives: To evaluate the effectiveness of wheelchair assessment and configuration on pressure injury incidence, mobility, and functioning in a wheelchair.

Design: Randomized controlled trial with participants individually randomized into intervention and control groups.

Setting: Nursing home.

Participants: Nursing home residents aged 60 and older who used wheelchairs and were at risk for pressure injuries (N=258).

Intervention: Treatment and evaluation, individually configured wheelchair and skin protection cushion; control and evaluation, facility-provided wheelchair and skin protection cushion.

Measurements: Pressure injury incidence, Nursing Home Life Space Diameter score, Functioning Every Day in a Wheelchair-Capacity (FEW-C) score, and Wheelchair Skills Test (WST) score.

Results: No differences in pressure injuries (p=.77) were found. Pelvic rotation (odds ratio (OR)=0.15, 95% confidence interval (CI)=0.03-0.70, p=.02) and Day 14 WST skill score (OR=0.74, 95% CI=0.60-0.91, p=.004) were significant predictors of pressure injuries. Significant differences were observed between groups in change in FEW-C independence scores between before randomization and endpoint (p=.03) and before randomization and 14 days (p=.04).

Conclusion: Participants with individually configured wheelchairs improved more in the safe and effective use of their wheelchairs than residents with facility-provided wheelchairs. The outcomes indicated that nursing home residents functioned safely at a higher level in their wheelchairs if their devices were individually configured using a comprehensive wheelchair and seating assessment process. There was no difference in the incidence of pressure injuries between the two groups.

Trial registration: NCT01275313.

Keywords: nursing home; pressure injury; pressure ulcer; wheelchairs.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Equipment Design / adverse effects
  • Equipment Design / methods*
  • Female
  • Geriatric Assessment
  • Homes for the Aged
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Nursing Homes
  • Outcome Assessment, Health Care
  • Pressure Ulcer / epidemiology
  • Pressure Ulcer / etiology
  • Pressure Ulcer / prevention & control*
  • Wheelchairs / adverse effects
  • Wheelchairs / statistics & numerical data*

Associated data

  • ClinicalTrials.gov/NCT01275313