Wheeled Mobility for Preventing Pressure Ulcers

Pressure ulcers are a significant healthcare problem for the growing number of nursing home residents in the United States and around the world. Pressure ulcers diminish quality of life, exact a devastating loss of function, increase the risk of death in geriatric populations and raise healthcare costs. Costs for the management of pressure ulcers in the US likely exceeds $6.4 billion annually, with a prevalence of approximately 12% in the high risk LTC population. A previous clinical trial at the University of Pittsburgh studied the effects of seat cushions on pressure ulcer incidence and found that when a skin protection seat cushion is used with a properly fitted wheelchair there is a significant reduction in incidence. The data led the investigators to question whether having a properly fitted wheelchair also has a significant effect on pressure ulcer incidence. This clinical trial investigate this question by randomizing subjects into a control group that receives a skin protection cushion and wheelchair training for use in their facility supplied wheelchair, or a treatment group that receives a skin protection cushion, wheelchair training and a new custom-fitted wheelchair. We expect that the treatment group will have a lower incidence of pressure ulcers.

Inclusion criteria

• Male or female nursing home resident 60 years of age and older
• A Braden score of less than or equal to 18
• A combined Braden Activity and Mobility Subscale score less than or equal to 5
• Absence of ischial and sacral area pressure ulcers (see definition of pressure ulcer)
• A tolerance for total daily wheelchair sitting time of greater than or equal to 6 hours (not continuous)
• Ability to accommodate seating and positioning needs with the wheelchair selected for use in this study (Breezy Ultra 4)
• Informed written consent

Exclusion criteria

• Body weight exceeding 250 lbs.
• Hip width exceeding 20 in.
• Wheelchair seating requirements for additional head support, seat depth > 20 inches, elevated leg rests or severe orthopedic deformities of the pelvis, lower extremities or back that exceed the accommodating capability of the Breezy Ultra 4 wheelchair.
• Current use of any cushioning material(s) other than a standard cushion, a folded pad, or a pillow (standard cushion as defined by HCPCS code for Standard Cushions, i.e., non-skin protection cushion)
• Current use of a HCPCS code K0004 wheelchair