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Promote Pressure Ulcer Healing in Individuals with Spinal Cord Injury Using an Individualized Cyclic Pressure-Relief Protocol

Makhsous, Mohsen PhD; Lin, Fang DSc; Knaus, Evan MD; Zeigler, Mary RN, MS, CRRN, CWOCN; Rowles, Diane M. MS, ACNP-BC, CRRN; Gittler, Michelle MD; Bankard, James BS; Chen, David MD

doi: 10.1097/01.ASW.0000305495.77649.ee
Features: Original Investigations

OBJECTIVE: To evaluate whether an individualized cyclic pressure-relief protocol accelerates wound healing in wheelchair users with established pressure ulcers (PrUs).

DESIGN: Randomized controlled study.

SETTING: Spinal cord injury clinics.

PARTICIPANTS: Forty-four subjects, aged 18-79 years, with a Stage II or Stage III PrU, were randomly assigned to the control (n = 22) or treatment (n = 22) groups.

INTERVENTIONS: Subjects in the treatment group used wheelchairs equipped with an individually adjusted automated seat that provided cyclic pressure relief, and those in the control group used a standard wheelchair. All subjects sat in wheelchairs for a minimum of 4 hours per day for 30 days during their PrU treatment.

MAIN OUTCOME MEASURES: Wound characteristics were assessed using the Pressure Ulcer Scale for Healing (PUSH) tool and wound dimensions recorded with digital photographs twice a week. Median healing time for a 30% healing relative to initial measurements, the percentage reduction in wound area, and the percentage improvement in PUSH score achieved at the end of the trial were compared between groups.

RESULTS: At the end of 30 days, both groups demonstrated a general trend of healing. However, the treatment group was found to take significantly less time to achieve 30% healing for the wound measurement compared with the control group. The percentage improvement of the wound area and PUSH scores were greater in using cyclic seating (45.0 ± 21.0, P < .003; 29.9 ± 24. 6, P < .003) compared with standard seating (10.2 ± 34.9, 5.8 ± 9.2).

CONCLUSIONS: The authors' findings show that cyclically relieving pressure in the area of a wound for seated individuals can greatly aid wound healing. The current study provides evidence that the individualized cyclic pressure-relief protocol helps promote pressure wound healing in a clinical setting. The authors concluded that the individualized cyclic pressure relief may have substantial benefits in accelerating the healing process in wheelchair users with existing PrUs, while maintaining the mobility of individuals with SCI during the PrU treatment.

In this study, the authors evaluate whether an individualized cyclic pressure relief protocol accelerates wound healing in wheelchair users with established pressure ulcers.

Mohsen Makhsous, PhD, is an Assistant Professor, Departments of Physical Therapy and Human Movement Sciences, Physical Medicine and Rehabilitation, Orthopaedic Surgery, Northwestern University, Chicago, Illinois; and is Research Scientist, Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois. Fang Lin, DSc, is a Research Assistant Professor, Departments of Physical Therapy and Human Movement Sciences, Physical Medicine and Rehabilitation, Northwestern University; and also works at Sensory Motor Performance Program, Rehabilitation Institute of Chicago. Evan Knaus, MD, is a PMR Resident, Physical Medicine and Rehabilitation, Northwestern University. Mary Zeigler, RN, MS, CRRN, CWOCN, is a Clinical Nurse Consultant, Sensory Motor Performance Program, Rehabilitation Institute of Chicago. Diane M. Rowles, MS, ACNP-BC, CRRN, is an Assistant Professor, Physical Medicine and Rehabilitation, Northwestern University; and is a Nurse Practitioner, Sensory Motor Performance Program, Rehabilitation Institute of Chicago. Michelle Gittler, MD, is a Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, University of Chicago, Chicago, Illinois. James Bankard, BS, is a Research Assistant, Departments of Physical Therapy and Human Movement Sciences, Northwestern University. David Chen, MD, is an Associate Professor, Physical Medicine and Rehabilitation, Northwestern University and Rehabilitation Institute of Chicago.

© 2009 Lippincott Williams & Wilkins, Inc.