The effect of seat shape on the risk of pressure ulcers using discomfort and interface pressure measurements.

BACKGROUND: It is clinically known that shape is important when selecting or designing a wheelchair support surface for the prevention of pressure ulcers (a £ 2 billion annual cost to the National Health Service, UK); however, the effect of different levels of shape contouring has not been adequately studied. OBJECTIVES: To investigate the effect of seat shape on the risk of pressure ulcers using discomfort and interface pressure measurements. STUDY DESIGN: Randomised, repeated trial. METHODS: Thirty able-bodied participants sat with restricted movement for 30 min in three sessions to evaluate two cushion shapes against a flat baseline surface. Visual Analog Scaling and pressure mapping were used to measure surrogates for pressure ulcer risk, discomfort and interface pressures, respectively. RESULTS: Linear regression revealed a reduction in discomfort (p < 0.05) on the custom contoured shapes. Interface pressures measured were also lower (p < 0.05) on the custom contoured shapes, and a negative Pearson's correlation (p < 0.05) indicated an association between smaller hip widths and increased discomfort for the commercially shaped cushion. CONCLUSIONS: The results of this study confirm that custom contoured shapes were effective at reducing pressure ulcer surrogate measures in the participants of this study and therefore suggests that the contribution of a cushion's three-dimensional contours on pressure ulcer risk should be further researched. CLINICAL RELEVANCE: The measurement of seat shape, discomfort and interface pressure in surrogate participants can help inform the design of wheelchair seating for individuals who are insensate or otherwise at risk of developing pressure ulcers. This knowledge can now be implemented using modern three-dimensional shape acquisition, analysis and fabrication technologies.

Predictors of poor attendance at an outpatient pulmonary rehabilitation programme.

BACKGROUND: Pulmonary rehabilitation (PR) is recommended for patients with respiratory disease who feel limited by breathlessness. Poor attendance wastes finite resources, increases waiting times and is probably associated with poorer clinical outcomes. We investigated what factors, identifiable from routine hospital data, predict poor attendance once enrolled in a pulmonary rehabilitation programme (PRP). METHODS: Retrospective case note study of 239 patients (60% male) of mean (S.D.) age of 66.6 (8.7) years, mean FEV(1) 39.6 (14.6)% predicted, who attended a 6 (short) or 18 (long) week, 18 session, outpatient PRP. Attendance data was analysed using linear multiple regression analysis with the log transformed odds ratio of attendance as the dependant variable. RESULTS: Overall median attendance was 16 out of 18 sessions. Being a current smoker (p<0.05), attending a long PRP (p<0.05), more previous hospital admissions (p<0.01), higher Medical Research Council (MRC) dyspnoea score (p<0.01) or enduring a long journey (p<0.001) were independent risk factors for low attendance. Lower body mass index (BMI) and distance from PR centre were of borderline importance (p<0.1) but age, gender, co-morbidity, respiratory diagnosis, FEV(1) and St. Georges Respiratory Questionnaire Score at baseline did not predict later attendance (p>0.2). CONCLUSIONS: Attendance at PRPs is independently influenced by smoking status, the degree of breathlessness, frequency of hospital admissions, length of the programme and journey time.

Simple interventions improve re-attendance when treating the sleep apnoea syndrome.

BACKGROUND AND PURPOSE: Interventions to improve treatment outcomes in sleep apnoea-hypopnoea syndrome (SAHS) have had mixed success. Most have concentrated on following the use of a continuous positive airway pressure (CPAP) machines; poorer users may not return for machine readings, so any compliance study must take into account rates of attendance rates. We hypothesised that a series of additional, early support measures would improve re-attendance over a sustained period. PATIENTS AND METHODS: Prospective, single-blinded interventional study. Seventy-two consecutive patients starting CPAP for SAHS were randomised to receive standard follow-up or extra early support. Attendance rates, CPAP use, Epworth scores, side-effects scores and number of changes to equipment were compared, by intent to treat, in both groups at 1 and 12 months. RESULTS: Re-attendance rates were higher in the intervention group at 1 month (P=0.04), 6 months (P=0.07) and 12 months (P=0.12). Those who defaulted tended previously to be poor users of the CPAP machine. For those who re-attended there was no difference in machine use or other outcomes. CONCLUSIONS: Simple interventions while commencing CPAP improve re-attendance with maximal benefit early on. This could provide more opportunities for solving problems early or considering alternative treatments. By confirming that poorer CPAP users eventually have higher default rates we recommend that future studies on CPAP compliance should first account for re-attendance rates.

Early predictors of CPAP use for the treatment of obstructive sleep apnea.

STUDY OBJECTIVES: To identify factors before a trial of nasal continuous positive airway pressure (CPAP) treatment that are associated with lower compliance. DESIGN: A prospective cohort study. Initial Hospital Anxiety and Depression Scale scores and other demographic data were noted. Machine use was recorded by clock timer after a 1-month trial of treatment. SETTING: District General Hospital sleep-disordered breathing clinic. PATIENTS OR PARTICIPANTS: Eighty consecutive patients with symptoms of sleep apnea-hypopnea syndrome and a 4% Sao2 desaturation index greater than 10 events per hour. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Those reporting 'initial problems' with CPAP went on to have an average of 2.4 hours of on time per night, while those not reporting initial problems had an on time of 5.0 hours per night (P < .001). Those living alone had a machine on time of 3.2 hours compared with 4.5 hours for those with partners (P = .04). Pearson's correlations between hours on time were -0.08 (P = .48) for initial Anxiety score and 0.10 (P = .37) for initial Depression score. CONCLUSIONS: There was no association between baseline anxiety and depression scores, as measured by the Hospital Anxiety and Depression Scale, and subsequent machine use. Other factors observable prior to commencing treatment, in particular, 'initial problems' (reported at autotitration), 'recent life-events' and 'living alone' were associated with lower machine use. Regarding all initial variables, reporting problems after the first night of nCPAP seems the most important predictor of ensuing machine use. A single screening question immediately after autotitration is useful in identifying those at high risk of treatment failure.