Objectives: To examine the impact of pressure mapping technology on the clinical decisions of occupational therapists and to examine the role of the Braden Scale in assisting with the selection of pressure-reducing cushions.
Design: Case studies.
Setting: Community.
Subjects: Forty clients.
Interventions: Clients were pressure mapped on their current seating surface and on four pre-selected cushions by the principal researcher. An occupational therapist completed the Braden Scale and a decision tree to assist in recommending a suitable pressure-reducing cushion.
Main outcome measures: Interface pressure maps, Braden Scale, and the cushion recommended, using a decision tree to guide clinical judgement.
Results: Thirty per cent (12) of the 40 cushions recommended were changed when the pressure maps from the Force Sensing Array (FSA) system were viewed. In 70% (26) of cases, the maps supported the cushion recommended. In 25% (10) of the cases, the maps showed that the client's current seating surface was unsuitable. After viewing the pressure maps, a surface other than the client's current surface was recommended in 47% (19) of the cases. There was a lack of agreement between the risk level of the clients as identified by the Braden Scale score, and the risk level of the clients as identified by the occupational therapist using a decision tree and the FSA maps.
Conclusion: Pressure mapping technology has a positive impact on clinical decisions regarding the provision of pressure-reducing cushions. Future research should examine the predictive validity of this technology. The Braden Scale may underpredict the risk level of the clients.
Get full access to this article
View all access options for this article.
References
1.
1 Marrie RA, Ross JB, Rockwood K. Pressure ulcers: prevalence, staging, and assessment of risk. Geriatrics Today2003; 6: 134-140.
2.
2 West P, Priestley J. Money under the mattress. Health Serv J1994; 14:20-22.
3.
3 Ragan R, Kernozek TW, Bidar M, Matheson JW. Seat interface pressure on various thicknesses of foam wheelchair cushions: a finite modelling approach. Arch Phys Med Rehabil2002; 83: 872-875.
4.
4 Geyer MJ, Brienza DM, Karg P, Trefler E, Kelsey S. A randomised controlled trial to evaluate pressure-reducing seat cushions for elderly wheelchair users. Adv Skin Wound Care2001; 14: 120-132.
5.
5 Cooper P, Gray D. Best practice statements: pressure ulcer prevention. Nurs Times2002; 98(27): 34-36.
6.
6 McDonald H. Preventing pressure ulcers. Interdisciplin J Rehabil2001; August/September. Accessed from www.rehabpub.com/ltrehab/892001/2.asp
7.
7 Gutierrez A. Pressure lessons. Interdisciplin J Rehabil2002; December. Accessed from www.rehabpub.com/features/122002/8.asp
8.
8 Haalboom JRE, Ruskens F. Risk assessment tools in the prevention of pressure ulcers. Abstracts from the first EPUAP Open Meeting. European Pressure Ulcer Advisory Panel, 2001. Accessed from www.epuap.org/abstracts/
9.
9 Rycroft-Malone J. Pressure ulcer risk assessment and prevention. London: Royal College of Nursing, 2001.
10.
10 Braden BJ, Bergstrom NA. A coneptual schema for the study of the etiology of pressure sores. Rehabil Nurs1987; 12:8-12.
11.
11 Bridel J. Risk assessment. J Tissue Viabil1994; 4: 84-85.
12.
12 Flanagan M. Who is at risk of a pressure sore? A practical review of risk assessment systems. Professional Nurse1993; February: 305-308.
13.
13 National Institute for Clinical Excellence. Pressure ulcer risk assessment and prevention. London: National Institute for Clinical Excellence, 2001.
14.
14 Taylor VC. Pressure mapping clinical protocol. In: Proceedings of the Canadian Seating and Mobility Conference, 1999. Toronto: Conference Organising Committee, 1999: 66-68.
15.
15 Sparacio J. Pressure mapping: potential benefits from technology. Accessed 2000 from www.rehabcentral.com/art-adee.cfm?artID/9014
16.
16 Roesler T. Sitting around: wheelchair cushion evaluation and education in pressure sore prevention. Team Rehab Report1997: 31-35.
18 Shapcott N, Levy B. By the numbers. Team Rehab Report1999: 16-21.
19.
19 Levy B. Which way is your tush leaning? In: Proceedings of the National Seating and Mobility Symposium. 1997. Accessed from www.pressuremapping.com/products/which-way
20.
20 Nicholson G, Ferguson-Pell M, Lennon P, Bain D. Comparative evaluation of pressure mapping systems (1): bench testing results. In: Proceedings of the Rehabilitation Engineering Society of North America, Florida. Arlington, VA: RESNA Press, 2001: 286-288.
21.
21 Stinson M, Porter A, Eakin P. Measuring change in interface pressure: effect of repositioning and sitting time. In: Proceedings of the Rehabilitation Engineering Society of North America, Florida. Arlington, VA: RESNA Press, 2001: 325-327.
22.
22 Clinical Resource Efficiency Support Team. Guidelines for the prevention and management of pressure sores: recommendations for practice. Belfast: CREST, 1998.
23.
23 Swain ID, Bader DL. The measurement of interface pressure and its role in soft tissue breakdown. J Tissue Viabil2002; 12: 132-147.
24.
24 Flaherty M. The seating clinic: a harmony for many parts. TeamRehab Report1999; May: 34-36.
25.
25 Ranalli NC, Moynahan JB. Use of a pressure mapping system for problem identification and seating intervention. In: Proceedings of the Rehabilitation Engineering Society of North America, Pittsburgh. Arlington, VA: RESNA Press, 1997: 219-221.
26.
26 Salvadalena GD, Snyder ML, Brogdon KE. Clinical trial of the Braden Scale on an acute care medical unit. J ET Nurs1992; 19: 160-165.
27.
27 Gould D, Goldstone L, Gammon J, Kelly D, Maidwell A. Establishing the validity of pressure ulcer risk assessment scales: a novel approach using illustrated patient scenarios. Int J Nurs Stud2002; 39: 215-228.
