The effect of wheelchair cushion properties on the microclimate at the cushion-user interface: A systematic review and meta-analysis.
microclimate
pressure injury
relative humidity
systematic review
temperature
wheelchair cushions
Journal
Australian occupational therapy journal
ISSN: 1440-1630
Titre abrégé: Aust Occup Ther J
Pays: Australia
ID NLM: 15420200R
Informations de publication
Date de publication:
31 Jan 2024
31 Jan 2024
Historique:
revised:
19
11
2023
received:
12
07
2023
accepted:
21
12
2023
medline:
1
2
2024
pubmed:
1
2
2024
entrez:
31
1
2024
Statut:
aheadofprint
Résumé
Pressure injuries are a preventable yet highly prevalent health concern. Wheelchair cushion prescription can have significant implications for wheelchair users' risk of pressure injury development, which can impact functional abilities and quality of life. The efficacy of a wheelchair cushion to redistribute pressure has been well-researched, but the efficacy to manage the microclimate is less clear, particularly in warm-hot environments. The aim of this study was to systematically review studies examining the effect of wheelchair cushions on temperature, moisture and thermal perception to determine which cushions are superior to improve these responses. A systematic review with meta-analyses of randomised cross-over and randomised control trials of wheelchair cushion interventions on measures of temperature, moisture, and thermal perception was conducted. Eight studies were identified that met the eligibility criteria and six meta-analyses were conducted. Pooled analyses identified a significantly lower temperature on foam-gel cushions compared to air cushions (MD = 0.80, 95% CI: 0.31, 1.29; p = 0.002) and a significantly lower temperature on foam-gel cushions compared to foam cushions (SMD = 0.76, 95%CI; 0.45, 1.06; p < 0.00001). Pooled analyses also demonstrated significantly lower relative humidity (i.e., moisture) on foam cushions compared to foam-gel cushions (p = 0.02). Differences in thermal perception were inconclusive due to limited data found. It is clear that not one cushion is ideal in managing all aspects of microclimate, as foam-gel cushions were the superior cushion to manage temperature and foam cushions were the superior cushion to manage moisture. This article provides occupational therapists and other health professionals with evidence-based information to assist with wheelchair cushion prescription that minimises the temperature and moisture accumulation, and associated risk of pressure injury for wheelchair users.
Identifiants
pubmed: 38296464
doi: 10.1111/1440-1630.12932
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Authors. Australian Occupational Therapy Journal published by John Wiley & Sons Australia, Ltd on behalf of Occupational Therapy Australia.
Références
Amini, D. (2018). Role of occupational therapy in wound management. The American Journal of Occupational Therapy, 72, 1-9. https://doi.org/10.5014/ajot.2018.72S212
Baker, E., & Leaper, D. (2003). Pressure-relieving properties of a intra-operative warming device. Journal of Wound Care, 12(4), 156-160. https://doi.org/10.12968/jowc.2003.12.4.26483
Black, J., Edsberg, L., Baharestani, M., Langemo, D., Goldberg, M., McNichol, L., Cuddigan, J., & National Pressure Ulcer Advisory Panel. (2011). Pressure ulcers: Avoidable or unavoidable? Results of the National Pressure Ulcer Advisory Panel Consensus Conference. Ostomy/Wound Management, 57(2), 24-37. https://www.o-wm.com/
Bogard, F., Polidori, G., Murer, S., Maalouf, C., Blancheteau, Y., Quinart, H., & Beaumont, F. (2023). Hygro-thermo-mechanical performance of wheelchair cushion technologies in the prevention of pressure ulcers and moisture-associated skin damages. Assistive Technology, 35(1), 64-73. https://doi.org/10.1080/10400435.2021.1949406
Braden, B., & Bergstrom, N. (2000). A conceptual schema for the study of the etiology of pressure sores. Rehabilitation Nursing, 25(3), 105-110. https://doi.org/10.1002/j.2048-7940.2000.tb01879.x
Call, E., Hetzel, T., McLean, C., Burton, J., & Oberg, C. (2017). Off loading wheelchair cushion provides best case reduction in tissue deformation as indicated by MRI. Journal of Tissue Viability, 26(3), 172-179. https://doi.org/10.1016/j.jtv.2017.05.002
Chapparo, C., Ranka, J., & Nott, M. (2017). The Occupational Performance Model (Australia): A description of constructs, structure and propositions. In M. Curtin, M. Egan, & J. Adams (Eds.), Occupational therapy for people experiences illness, injury or impairment (7th ed.). Elsevier.
Coleman, S., Gorecki, C., Nelson, E., Closs, S., Defloor, T., Halfens, R., Farrin, A., Brown, J., Schoonhoven, L., & Nixon, J. (2013). Patient risk factors for pressure ulcer development: Systematic review. International Journal of Nursing Studies, 50(7), 974-1003. https://doi.org/10.1016/j.ijnurstu.2012.11.019
Consortium for Spinal Cord Medicine. (2014). Pressure ulcer prevention and treatment following spinal cord injury: a clinical practice guideline for health care professionals.
Dattoli, S., Colucci, M., Soave, M., De Santis, R., Segaletti, L., Corsi, C., Tofani, M., Valente, D., & Galeoto, G. (2020). Evaluation of pelvis postural systems in spinal cord injury patients: Outcome research. The Journal of Spinal Cord Medicine, 43(2), 185-192. https://doi.org/10.1080/10790268.2018.1456768
Denzinger, M., Krauss, S., Held, M., Joss, L., Kolbenschlag, J., Daigeler, A., & Rothenberger, J. (2020). A quantitative study of hydration level of the skin surface and erythema on conventional and microclimate management capable mattresses and hospital beds. Journal of Tissue Viability, 29(1), 2-6. https://doi.org/10.1016/j.jtv.2019.12.001
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, & Pan Pacific Pressure Injury Alliance. (2019). Prevention and treatment of pressure ulcers/injuries: Quick reference guide.
Ferrarin, M., Andreoni, G., & Pedotti, A. (2000). Comparative biomechanical evaluation of different wheelchair seat cushions. Journal of Rehabilitation Research and Development, 37(3), 315-324. https://ezproxy.scu.edu.au/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=107010503&site=ehost-live
García-Molina, P., Casasus, S. R., Sanchis-Sánchez, E., Balaguer-López, E., Ruescas-López, M., & Blasco, J.-M. (2021). Evaluation of interface pressure and temperature management in five wheelchair seat cushions and their effects on user satisfaction. Journal of Tissue Viability, 30(3), 402-409. https://doi.org/10.1016/j.jtv.2021.05.004
Gefan, A. (2014). Tissue changes in patients following spinal cord injury and implications for wheelchair cushions and tissue loading: A literature review. Ostomy/Wound Management, 60(2), 34-45.
He, C., & Shi, P. (2020). Interface pressure reduction effects of wheelchair cushions in individuals with spinal cord injury: A rapid review. Disability and Rehabilitation, 44(6), 826-833. https://doi.org/10.1080/09638288.2020.1782487
Higgins, J. P. T., Savović, J., Page, M., Elbers, R., & Sterne, J. A. C. (2019). Assessing risk of bias in a randomized trial. In J. P. T. Higgins, J. Thomas, J. Chandler, M. Cumpston, T. Li, M. J. Page, & V. A. Welch (Eds.), Cochrane handbook for systematic reviews of interventions (2nd ed., pp. 205-228). Wiley-Blackwell. https://doi.org/10.1002/9781119536604.ch8
Hodges, G., Mallette, M., Rigby, A., Klentrou, P., Cheung, S., & Falk, B. (2019). Comparison of different wheelchair seating on thermoregulation and perceptual responses in thermoneutral and hot conditions in children. Journal of Tissue Viability, 28(3), 144-151. https://doi.org/10.1016/j.jtv.2019.04.003
Hollington, J., & Hillman, S. (2013). Can static interface pressure mapping be used to rank pressure redistributing cushions for active wheelchair users? Journal of Rehabilitation Research and Development, 50(1), 53-60. https://doi.org/10.1682/JRRD.2011.10.0192
Hopkins, W. G., Marshall, S. W., Batterham, A. M., & Hanin, J. (2009). Progressive statistics for studies in sports medicine and exercise science. Medicine and Science in Sports and Exercise, 41(1), 3-12. https://doi.org/10.1249/MSS.0b013e31818cb278
Houghton, P., Campbell, K., & CPG Panel. (2013). Canadian best practice guidelines for the prevention and management of pressure ulcers in people with spinal cord injury. A resource handbook for clinicians. http://www.onf.org
Hsu, T., Yang, S., Liu, J., Pan, C., & Yang, Y. (2018). The effect of cushion properties on skin temperature and humidity at the body-support interface. Assistive Technology, 30(1), 1-8. https://doi.org/10.1080/10400435.2016.1223208
Kottner, J., Black, J., Call, E., Gefen, A., & Santamaria, N. (2018). Microclimate: A critical review in the context of pressure ulcer prevention. Clinical Biomechanics, 59, 62-70. https://doi.org/10.1016/j.clinbiomech.2018.09.010
Liu, Z., Cascioli, V., Heusch, A., & McCarthy, P. (2011). Studying thermal characteristics of seating materials by recording temperature from 3 positions at the seat-subject interface. Journal of Tissue Viability, 20(3), 73-80. https://doi.org/10.1016/j.jtv.2011.04.002
Liu, Z., Cheng, H., Luo, Z., Cascioli, V., Heusch, A., Nair, N., & McCarthy, P. (2017). Performance assessment of a humidity measurement system and its use to evaluate moisture characteristics of wheelchair cushions at the user-seat interface. Sensors, 17(4), 775. https://doi.org/10.3390/s17040775
Macens, K., Rose, A., & Mackenzie, L. (2011). Pressure care practice and occupational therapy: Findings of an exploratory study. Australian Occupational Therapy Journal, 58(5), 346-354. https://doi.org/10.1111/j.1440-1630.2011.00962.x
McInnes, E., Jammali-Blasi, A., Bell-Syer, S., Dumville, J., & Cullum, N. (2012). Preventing pressure ulcers-Are pressure-redistributing support surfaces effective? A cochrane systematic review and meta-analysis. International Journal of Nursing Studies, 49(3), 345-359. https://doi.org/10.1016/j.ijnurstu.2011.10.014
McInnes, E., Jammali-Blasi, A., Bell-Syer, S., Dumville, J. C., Middleton, V., & Cullum, N. (2015). Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews, 2015, CD001735. https://doi.org/10.1002/14651858.CD001735.pub5
Moore, Z., Van Etten, M., & Dumville, J. (2016). Bed rest for pressure ulcer healing in wheelchair users. Cochrane Database of Systematic Reviews, 2016, CD011999. https://doi.org/10.1002/14651858.CD011999.pub2
Moore, Z. E. H., & Patton, D. (2019). Risk assessment tools for the prevention of pressure ulcers. Cochrane Database of Systematic Reviews, 2019, CD006471. https://doi.org/10.1002/14651858.CD006471.pub4
Nguyen, K., Chaboyer, W., & Whitty, J. (2015). Pressure injury in Australian public hospitals: A cost-of-illness study. Australian Health Review, 39(3), 329-336. https://doi.org/10.1071/AH14088
Olesen, C., De Zee, M., & Rasmussen, J. (2010). Missing links in pressure ulcer research-An interdisciplinary overview. Journal of Applied Physiology, 108(6), 1458-1464. https://doi.org/10.1152/japplphysiol.01006.2009
Page, M., McKenzie, J., Bossuyt, P., Boutron, I., Hoffmann, T., Mulrow, C., Shamseer, L., Tetzlaff, J., & Moher, D. (2021). Updating guidance for reporting systematic reviews: Development of the PRISMA 2020 statement. Journal of Clinical Epidemiology, 134, 103-112. https://doi.org/10.1016/j.jclinepi.2021.02.003
Reger, S., Ranganathan, V., & Sahgal, V. (2007). Support surface interface pressure, microenvironment, and the prevalence of pressure ulcers: An analysis of the literature. Ostomy/Wound Management, 53(10), 50-58. https://ezproxy.scu.edu.au/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=105816683&site=ehost-live
Stockton, L., & Rithalia, S. (2009). Pressure-reducing cushions: Perceptions of comfort from the wheelchair users' perspective using interface pressure, temperature and humidity measurements. Journal of Tissue Viability, 18(2), 28-35. https://doi.org/10.1016/j.jtv.2007.09.006
The Cochrane Collaboration. (2020). Review Manager (RevMan). In (Version 5.4)
Tzen, Y., Brienza, D., & Karg, P. (2019). Implementing local cooling to increase skin tolerance to ischemia during normal seating in people with spinal cord injury. Journal of Tissue Viability, 28(4), 173-178. https://doi.org/10.1016/j.jtv.2019.09.006
Wingo, J. E., Low, D. A., Keller, D. M., Brothers, R. M., Shibasaki, M., & Crandall, C. G. (2010). Skin blood flow and local temperature independently modify sweat rate during passive heat stress in humans. Journal of Applied Physiology, 109(5), 1301-1306. https://doi.org/10.1152/japplphysiol.00646.2010
Yang, Y., Pan, C., & Ho, W. (2018). Sensor-based remote temperature and humidity monitoring device embedded in wheelchair cushion. Sensors and Materials, 30(8), 1807. https://doi.org/10.18494/SAM.2018.1872
Yuen, H., & Garrett, D. (2001). Case report - comparison of three wheelchair cushions for effectiveness of pressure relief. American Journal of Occupational Therapy, 55(4), 470-475. https://doi.org/10.5014/ajot.55.4.470