Reducing pressure with the goal of improving outcomes: a retrospective chart review of cushion evaluations and recommendations at one seating clinic

Abstract

Purpose To describe the current seating recommendations made by a seating clinic for wheelchair users who presented with a Pressure Injury (PrI) or history of PrI. Methods Retrospective review of electronic medical records of 133 adults who used a wheelchair as their primary means of mobility who had a cushion evaluation during which interface pressure mapping data was documented. Results Clinicians adjusted 71% of participants’ wheelchair cushions, including 49% who received a new cushion, and 37% of participants’ wheelchairs. The most common adjustments besides receiving a new cushion were: addition of an underlay, adjusting the inflation of a cushion, and adjustments to the foot or back support of the wheelchair. Forty-five participants only received adjustments (i.e. no new cushion), while 23 participants only received education and feedback rather than equipment modifications. Those 23 participants had significantly lower Peak Pressure Index (PPI) than those who received equipment modifications (mean [95% CI] 76.7 [59.1, 94.3] versus 111.6 [102.1, 121.2] respectively, p = 0.001). The PPI was reduced by an average of 22.5 mmHg from the initial to final seating system amongst those who received modifications ([13.9–31.0], p<.001). Conclusions The seating clinicians considered interface pressure mapping in their decision-making and effectively reduced interface pressures with their interventions. Cushion replacement is important when someone presents with a PrI. However, adjusting an existing wheelchair cushion and/or seating system provides important additions and alternatives to consider for reducing interface pressure. There is also a role for education about proper use of equipment, weight shifts, and alternate seating surfaces. IMPLICATIONS FOR REHABILITATION A cushion evaluation may involve evaluating more than one cushion configuration and using pressure mapping to compare the best options. To address perceived wheelchair cushion issues, posture and positioning should be evaluated and adjusted as necessary, in addition to evaluating the cushion itself. Common positioning modifications include: modifying/adding cushion underlays or inflation and foot and back supports in response to clients’ changing postural needs and wheelchair components coming out of optimal position due to wear and tear. Adjustments to the wheelchair and cushion aim to distribute body weight over a larger surface area, reduce pressure at high-risk locations, improve posture, and increase function. These adjustments should consider individual’s specific needs and goals, while also being mindful of funding barriers.