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

2018; Wiley; Volume: 66; Issue: 9 Linguagem: Inglês

10.1111/jgs.15495

1532-5415

David M. Brienza, Patricia Karg, Marnie Bertolet, Mark R. Schmeler, Prerna Poojary‐Mazzotta, Helen Vlachos, Debora Wilkinson,

Spinal Cord Injury Research

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