If you sit in a wheelchair long term, switch to a pressure-relieving cushion and check the ischial and coccygeal skin once a day
UpdatedGrade BMedium benefitLifespanLow costLittle timeSome willpower
In nursing homes, older adults on pressure-relieving cushions had clearly fewer pressure ulcers at the sitting bones than those on ordinary segmented foam cushions, but when the coccyx was counted together the difference did not show. Everyone in the trial first got a fitted wheelchair, so the chair itself must be sized to the person — a generic model is not enough.
- Cost
- One pressure-relieving cushion costs a few hundred to over 1000 yuan. One look a day takes one minute.
- Benefit
- This randomized clinical trial ran in 12 nursing homes, enrolling in 2004 to 2008 232 residents aged 65 or older who sat in a wheelchair 6 or more hours a day with a Braden score under 18. Everyone first received a fitted wheelchair, then was randomized into two groups. One used skin-protection cushions (air, viscous fluid plus foam, or gel plus foam); the other used segmented foam cushions 7.6 cm thick. Follow-up was 6 months or until a pressure ulcer occurred. Ischial tuberosity pressure ulcers: segmented foam 8 cases (6.7%), skin-protection 1 case (0.9%), P=0.04. Combining ischial and sacrococcygeal ulcers: segmented foam 21 cases (17.6%), skin-protection 12 cases (10.6%), P=0.14 — no difference shown
- Notes
- Grade B for two reasons. First, the sample is only 232 people; the primary endpoint P value 0.04 just cleared the line, and the secondary endpoint showed no difference. Second, the sample is older nursing-home residents; applying it to younger wheelchair users is an extrapolation. Everyone in the trial first got a fitted wheelchair, so “fit” and “cushion” work together — do not only swap the cushion. Pressure-ulcer prevention for long-term bed rest, air mattresses, and timed turning are in Section 17, item 8 (pressure ulcers). How to apply for subsidies for basic assistive devices is in item 7 of this section (ask the county Disabled Persons’ Federation (残联) for the full list).
Sources · 1
- Brienza D, Kelsey S, Karg P, et al. (2010). A randomized clinical trial on preventing pressure ulcers with wheelchair seat cushions. Journal of the American Geriatrics Society, 58(12):2308-2314. doi.org/10.1111/j.1532-5415.2010.03168.x