University of Pittsburgh Study Highlights Ability of Skin-Protection Cushions to Prevent Pressure Sores

A newly published study by the University of Pittsburgh in the Journal of the American Geriatrics Society says skin-protection wheelchair seat cushions, when used with fitted wheelchairs, lowered the incidence of pressure ulcers in geriatric nursing home patients.

The 2004-2008 study featured 180 nursing home residents who were older than 65, were at high risk of developing pressure sores and spent six or more hours per day in their wheelchairs. All patients in the study were provided with "fitted manual wheelchairs," according to a report about the study's findings. But participants in one group received one of three skin-protection seat cushions, while members of the other group received a "7.6-cm-thick, crosscut foam cushion, representing the standard of care at the time of the study."

After six months of using the respective cushions, 0.9 percent of patients in the skin-protection cushion group had developed pressure ulcers near their ischial tuberosities (IT), while 6.7 percent of the participants using the foam cushions had developed pressure sores in that location.

Another analysis showed that 17.6 percent of patients using the foam cushions had developed combined IT and sacral ulcers, while 10.6 percent of patients using skin-protection cushions had sustained the same sorts of sores.

David Brienza, Ph.D., the principal investigator of the study, said, "This study was the first randomized, large-scale wheelchair cushion efficacy trial that controlled for most of the important confounding variables."

Brienza, who is a professor in the University of Pittsburgh's department of rehabilitation science & technology, added, "The results clearly show that the use of an appropriate wheelchair cushion in a properly fitted wheelchair helps to prevent pressure ulcers for older people who use wheelchairs in nursing homes."

The skin-protection cushions used in the study included a range of materials, including air (The ROHO Group's Quadtro Select), viscous fluid and foam (Sunrise Medical's JAY 2 Deep), and gel and foam (Invacare's Infinity Gentle Contour FloGel).

The objective of the study, funded by the National Institutes of Health, was "to determine the efficacy of skin-protection wheelchair seat cushions in preventing pressure ulcers in the elderly nursing home population." The study took place at 12 nursing homes, and all participants had a Braden score of 18 or less, and a combined Braden activity and mobility score of 5 or less.

The Braden scale is one of the measures commonly used to assess a patient's risk for developing pressure sores. The scale considers such factors as a patient's mobility, sensory perception, activity levels and nutrition.

Mark Schmeler, Ph.D., OTR/L, ATP, the study's co-investigator, said, "The findings are not surprising given they are consistent with what we know and observe as clinicians. Seating interventions for this population have typically been marginal at best given most facilities do not want to spend the money on properly fitted wheelchair cushions. Hopefully these results combined with other research can mobilize some policy changes to get people the equipment they need."

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at

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