Application of immersive virtual reality mirror therapy for upper limb rehabilitation after stroke: a scoping review.

Mirror therapy is a commonly used rehabilitation intervention in post stroke upper limb rehabilitation. Despite many potential technological developments, mirror therapy is routinely delivered through the use of a static mirror or mirror box. This review aims to synthesise evidence on the application of immersive virtual reality mirror therapy (IVRMT) in poststroke upper limb rehabilitation. A scoping review was performed on relevant English studies published between 2013 to 2023. Literature search was undertaken on APA PsycInfo, CINAHL, Cochrane Library, MEDLINE, PubMed and Web of Science between August 5 and 17, 2023. Additional studies were included from Google Scholar and reference lists of identified articles. A total of 224 records were identified, of which 8 full-text articles were selected for review. All included studies were published between 2019 and 2023, and from high- and upper-middle-income nations. All the studies were experimental (n = 8). The total sample size in the studies was 259, most of whom were stroke patients with upper limb weakness (n = 184). This review identified three major themes and two sub-themes based on the contents of the studies conducted on the application of IVRMT: IVRMT's technical application, feasibility and impact on clinical outcomes (motor recovery and adverse events). IVRMT was concluded to be a safe and feasible approach to post-stroke upper limb rehabilitation, offering enhanced engagement and motor recovery. However, more methodologically robust studies should be conducted to advance this area of practice, and to include a uniform IVRMT intervention protocol, dose, and use of outcome measure.

Spatial Neglect: An Exploration of Clinical Assessment Behaviour in Stroke Rehabilitation.

OBJECTIVE: There is a large gap between evidence-based recommendations for spatial neglect assessment and clinical practice in stroke rehabilitation. We aimed to describe factors that may contribute to this gap, clinician perceptions of an ideal assessment tool, and potential implementation strategies to change clinical practice in this area. DESIGN: Qualitative focus group investigation. Focus group questions were mapped to the Theoretical Domains Framework and asked participants to describe their experiences and perceptions of spatial neglect assessment. SETTING: Online stroke rehabilitation educational bootcamp. PARTICIPANTS: A sample of 23 occupational therapists, three physiotherapists, and one orthoptist that attended the bootcamp. INTERVENTION: Prior to their focus group, participants watched an hour-long educational session about spatial neglect. MAIN MEASURES: A deductive analysis with the Theoretical Domains Framework was used to describe perceived determinants of clinical spatial neglect assessment. An inductive thematic analysis was used to describe perceptions of an ideal assessment tool and practice-change strategies in this area. RESULTS: Participants reported that their choice of spatial neglect assessment was influenced by a belief that it would positively impact the function of people with stroke. However, a lack of knowledge about spatial neglect assessment appeared to drive low clinical use of standardised functional assessments. Participants recommended open-source online education involving a multidisciplinary team, with live-skill practice for the implementation of spatial neglect assessment tools. CONCLUSIONS: Our results suggest that clinicians prefer functional assessments of spatial neglect, but multiple factors such as knowledge, training, and policy change are required to enable their translation to clinical practice.

Preventing facial pressure injuries among health care staff working in diverse COVID-19 care environments.

The aim of this study was to determine the impact of a specially designed care bundle on the development of facial pressure injuries among frontline health care workers wearing personal protective equipment (PPE) during the COVID-19 pandemic. This was a mixed methods study. First, a pre-posttest observational design was employed to evaluate the impact of the pre-piloted intervention, a care bundle including skin cleansing and hydration, protective material use, facemask selection and skin inspection, developed in line with international best practice guidelines. Data were collected using survey methodology. Frontline COVID-19 staff working in acute, community and ambulance services were invited to participate. Then, judgemental and volunteer sampling was used to select participants to undertake semi-structured interviews to elicit feedback on their perceptions of the care bundle. The sample included 120 acute hospital staff, 60 Ambulance staff, 24 Community Hub staff and 20 COVID-19 testing centre staff. A survey response rate of 61% was realised (n = 135/224). Of the participants, 32% (n = 43) had a facial pressure ulcer (FPI) pre-intervention and 13% (n = 18) developed an FPI while using the care bundle. The odds ratio (OR) was 0.33 (95% CI: 0.18 to 0.61; P = .0004), indicating a 77% reduction in the odds of FPI development with use of the care bundle. Analysis of the qualitative data from 22 interviews identified three key themes, the context for the care bundle, the ease of use of the care bundle and the care bundle as a solution to FPI development. The care bundle reduced the incidence of FPI among the participants and was found to be easy to use. Implementation of skin protection for frontline staff continues to be important given the persistently high incidence of COVID-19 and the ongoing need to wear PPE for protracted durations.

Joining the workforce during the COVID-19 pandemic: views of Allied Health Profession students.

In the United Kingdom, the onset of the COVID-19 pandemic placed great pressures on universities to ensure final year health care students completed their studies earlier than planned in order to join the National Health Service workforce. This study aimed to explore the anticipations and support needs of final year allied health profession students transitioning to practice during a pandemic. Final year university students across seven healthcare professions were asked to complete an online survey. Demographic data were analyzed by descriptive statistics and responses to open questions were explored using content analysis. Sixty participants completed the survey. Content analysis regarding students' anticipations, fears, and support needs identified the following themes: professional identity and growth; opportunities for improvement; preparedness for transition from university to the workplace, the workplace environment; COVID-19; support from lecturers; daily support within the workplace and innovative methods of support. Although the transition from student to practitioner continues to be a stressful period, only a minority of participants reported COVID-19 as an explicit stressor. However, as the effects of COVID-19 continue to evolve in the United Kingdom, universities and healthcare trusts must ensure adequate supports are in place for recent graduates navigating this transition during a healthcare crisis.

Education of healthcare professionals for preventing pressure ulcers.

BACKGROUND: Pressure ulcers, also known as bed sores or pressure sores, are localised areas of tissue damage arising due to excess pressure and shearing forces. Education of healthcare staff has been recognised as an integral component of pressure ulcer prevention. These educational programmes are directed towards influencing behaviour change on the part of the healthcare professional, to encourage preventative practices with the aim of reducing the incidence of pressure ulcer development. OBJECTIVES: To assess the effects of educational interventions for healthcare professionals on pressure ulcer prevention. SEARCH METHODS: In June 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and cluster-RCTs, that evaluated the effect of any educational intervention delivered to healthcare staff in any setting to prevent pressure ulceration. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed titles and abstracts of the studies identified by the search strategy for eligibility. We obtained full versions of potentially relevant studies and two authors independently screened these against the inclusion criteria. MAIN RESULTS: We identified five studies that met the inclusion criteria for this review: four RCTs and one cluster-RCT. The study characteristics differed in terms of healthcare settings, the nature of the interventions studied and outcome measures reported. The cluster-RCT, and two of the RCTs, explored the effectiveness of education delivered to healthcare staff within residential or nursing home settings, or nursing home and hospital wards, compared to no intervention, or usual practices. Educational intervention in one of these studies was embedded within a broader, quality improvement bundle. The other two individually randomised controlled trials explored the effectiveness of educational intervention, delivered in two formats, to nursing staff cohorts.Due to the heterogeneity of the studies identified, pooling was not appropriate and we have presented a narrative overview. We explored a number of comparisons (1) education versus no education (2) components of educational intervention in a number of combinations and (3) education delivered in different formats. There were three primary outcomes: change in healthcare professionals' knowledge, change in healthcare professionals' clinical behaviour and incidence of new pressure ulcers.We are uncertain whether there is a difference in health professionals' knowledge depending on whether they receive education or no education on pressure ulcer prevention (hospital group: mean difference (MD) 0.30, 95% confidence interval (CI) -1.00 to 1.60; 10 participants; nursing home group: MD 0.30, 95% CI -0.77 to 1.37; 10 participants). This was based on very low-certainty evidence from one study, which we downgraded for serious study limitations, indirectness and imprecision.We are uncertain whether there is a difference in pressure ulcer incidence with the following comparisons: training, monitoring and observation, versus monitoring and observation (risk ratio (RR) 0.63, 95% CI 0.37 to 1.05; 345 participants); training, monitoring and observation, versus observation alone (RR 1.21, 95% CI 0.60 to 2.43; 325 participants) or, monitoring and observation versus observation alone (RR 1.93, 95% CI 0.96 to 3.88; 232 participants). This was based on very low-certainty evidence from one study, which we downgraded for very serious study limitations and imprecision. We are uncertain whether multilevel intervention versus attention control makes any difference to pressure ulcer incidence. The report presented insufficient data to enable further interrogation of this outcome.We are uncertain whether education delivered in different formats such as didactic education versus video-based education (MD 4.60, 95% CI 3.08 to 6.12; 102 participants) or e-learning versus classroom education (RR 0.92, 95% CI 0.80 to 1.07; 18 participants), makes any difference to health professionals' knowledge of pressure ulcer prevention. This was based on very low-certainty evidence from two studies, which we downgraded for serious study limitations and study imprecision.None of the included studies explored our other primary outcome: change in health professionals' clinical behaviour. Only one study explored the secondary outcomes of interest, namely, pressure ulcer severity and patient and carer reported outcomes (self-assessed quality of life and functional dependency level respectively). However, this study provided insufficient information to enable our independent assessment of these outcomes within the review. AUTHORS' CONCLUSIONS: We are uncertain whether educating healthcare professionals about pressure ulcer prevention makes any difference to pressure ulcer incidence, or to nurses' knowledge of pressure ulcer prevention. This is because the included studies provided very low-certainty evidence. Therefore, further information is required to clarify the impact of education of healthcare professionals on the prevention of pressure ulcers.

Exploring repositioning movements in sitting with 'at risk' groups using accelerometry and interface pressure mapping technologies.

BACKGROUND: Despite high quality guidelines underpinning pressure ulcer care (NPUAP/EPUAP/PPPIA, 2014), pressure ulceration still poses a significant financial impact on health care services in treatment and staff costs as well as having a profound effect on the health and quality of life of individuals experiencing them. Repositioning is a key preventative technique recommended by occupational therapists and other health care professionals. The frequency and quality of repositioning movements performed by individuals, however, can be difficult to determine. This paper explores the use of technology in monitoring repositioning movements in sitting. OBJECTIVE: To explore the outputs of technologies such as interface pressure mapping systems and accelerometers in enabling the therapist to accurately monitor seated behaviour and enhance practice through targeted interventions to prevent sitting acquired pressure ulceration. METHOD: Reviewing the findings of two recent research studies with 'at risk' cohorts (spinal cord injury; elderly orthopaedic), using accelerometry and seated interface pressures, this paper will highlight how useful this technology is in clinical practice to monitor weight shifts and repositioning behaviours. RESULT: Both studies illustrated that the majority of individuals did not adhere to the frequency or magnitude of movements currently recommended to redistribute seating interface pressures. When repositioning was performed it was ineffective in reducing seated pressures. CONCLUSION: In an era of personalised medicine, technology has an important role to play in providing the service user, caregivers and healthcare staff with important biofeedback information about seated behaviours, particularly those that minimise the risk of developing sitting acquired pressure ulcers. This information can augment occupational therapists' clinical decision-making in maximising active pressure ulcer prevention.

The effectiveness of interventions aimed at increasing physical activity in adults with persistent musculoskeletal pain: a systematic review and meta-analysis.

BACKGROUND: Individuals with persistent musculoskeletal pain (PMP) have an increased risk of developing co-morbid health conditions and for early-mortality compared to those without pain. Despite irrefutable evidence supporting the role of physical activity in reducing these risks; there has been limited synthesis of the evidence, potentially impacting the optimisation of these forms of interventions. This review examines the effectiveness of interventions in improving levels of physical activity and the components of these interventions. METHODS: Randomised and quasi-randomised controlled trials were included in this review. The following databases were searched from inception to March 2016: CENTRAL in the Cochrane Library, Cochrane Database of Systematic Reviews (CDSR), MEDLINE, Embase, CINAHL, PsycINFO and AMED. Two reviewers independently screened citations, assessed eligibility, extracted data, assessed risk of bias and coded intervention content using the behaviour change taxonomy (BCTTv1) of 93 hierarchically clustered techniques. GRADE was used to rate the quality of the evidence. RESULTS: The full text of 276 articles were assessed for eligibility, twenty studies involving 3441 participants were included in the review. Across the studies the mean number of BCTs coded was eight (range 0-16); with 'goal setting' and 'instruction on how to perform the behaviour' most frequently coded. For measures of subjective physical activity: interventions were ineffective in the short term, based on very low quality evidence; had a small effect in the medium term based on low quality evidence (SMD 0.25, 95% CI 0.01 to 0.48) and had a small effect in the longer term (SMD 0.21 95% CI 0.08 to 0.33) based on moderate quality evidence. For measures of objective physical activity: interventions were ineffective - based on very low to low quality evidence. CONCLUSIONS: There is some evidence supporting the effectiveness of interventions in improving subjectively measured physical activity however, the evidence is mostly based on low quality studies and the effects are small. Given the quality of the evidence, further research is likely/very likely to have an important impact on our confidence in effect estimates and is likely to change the estimates. Future studies should provide details on intervention components and incorporate objective measures of physical activity.

Gaming for health: a systematic review of the physical and cognitive effects of interactive computer games in older adults.

This systematic review examined the physical and cognitive effects of physically based interactive computer games (ICGs) in older adults. Literature searching was carried out from January 2000 to June 2011. Eligible studies were trials involving older adults (>65 years) describing the effects of ICGs with a physical component (aerobic, strength, balance, flexibility) on physical or cognitive outcomes. Secondary outcomes included adverse effects, compliance, and enjoyment. Twelve trials met the inclusion criteria. ICG interventions varied in terms of software, game type, and nature of the computer interaction. Although there was preliminary evidence that ICG is a safe and effective exercise intervention for older adults, the dearth of high-quality evidence limits this finding. No major adverse effects were reported and two studies reported minor events. ICG could be improved further by tailoring interventions for older adults; in particular, they should aim to optimize participant safety, motivation, and enjoyment for this population.

A systematic review of interventions aimed at increasing physical activity in adults with chronic musculoskeletal pain--protocol.

BACKGROUND: Chronic musculoskeletal pain is highly prevalent, affecting around one in five people across Europe. Osteoarthritis, low back pain, neck pain and other musculoskeletal disorders are leading causes of disability worldwide and the most common source of chronic pain. Exercise and/or physical activity interventions have the potential to address not only the pain and disability associated with chronic pain but also the increased risk of morbidity and mortality seen in this population. Although exercise and/or physical activity is widely recommended, there is currently a paucity of research that offers an evidence base upon which the development or optimisation of interventions can be based. This systematic review will investigate the components of interventions associated with changes in physical activity levels in adults with chronic musculoskeletal pain. METHODS/DESIGN: This systematic review will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidance. Randomised and quasi-randomised controlled trials of interventions aimed at increasing physical activity in adults with chronic musculoskeletal pain will be included. Articles will be identified through a comprehensive search of the following databases: CENTRAL in the Cochrane Library, the Cochrane Database of Systematic Reviews (CDSR), MEDLINE, Embase, CINAHL, PsycINFO and AMED. Two review authors will independently screen articles retrieved from the search for eligibility, extract relevant data on methodological issues and code interventions according to the behaviour change technique taxonomy (v1) of 93 hierarchically clustered techniques. As complex healthcare interventions can be modified by a wide variety of factors, data will be summarised statistically when the data are available, are sufficiently similar and are of sufficient quality. A narrative synthesis will be completed if there is insufficient data to permit a formal meta-analysis. DISCUSSION: This review will be of value to clinicians working in chronic pain services and to researchers involved in designing and evaluating interventions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO reference: CRD42014010640.

Impact of Multiplayer Online Role-Playing Games upon the Psychosocial Well-Being of Adolescents and Young Adults: Reviewing the Evidence.

Introduction. For many people, the online environment has become a significant arena for everyday living, and researchers are beginning to explore the multifaceted nature of human interaction with the Internet. The burgeoning global popularity and distinct design features of massively multiplayer online role-playing games (MMORPGs) have received particular attention, and discourses about the phenomenon suggest both positive and negative impact upon gamer health. Aim. The purpose of this paper was to critically appraise the research literature to determine if playing MMORPGs impacts upon the psychosocial well-being of adolescents and young adults. Method. Initial searches were conducted on nine databases spanning the years 2002 to 2012 using key words, such as online gaming, internet gaming, psychosocial, and well-being, which, in addition to hand searching, identified six studies meeting the inclusion and exclusion criteria for this review. Results. All six studies strongly associated MMORPG playing with helpful and harmful impact to the psychosocial well-being of the populations under study; however due to the methodologies employed, only tentative conclusions may be drawn. Conclusion. Since both helpful and harmful effects were reported, further multidisciplinary research is recommended to specifically explore the clinical implications and therapeutic potentialities of this modern, growing phenomenon.

Spinal cord injury and pressure ulcer prevention: using functional activity in pressure relief.

Background. People with spinal cord injury (SCI) are at increased risk of pressure ulcers due to prolonged periods of sitting. Concordance with pressure relieving movements is poor amongst this population, and one potential alternative to improve this would be to integrate pressure relieving movements into everyday functional activities. Objectives. To investigate both the current pressure relieving behaviours of SCI individuals during computer use and the application of an ergonomically adapted computer-based activity to reduce interface pressure. Design. Observational and repeated measures design. Setting. Regional Spinal Cord Injury Unit. Participants. Fourteen subjects diagnosed with SCI (12 male, 2 female). Intervention.Comparing normal sitting to seated movements and induced forward reaching positions. Main Outcome Measures. Interface pressure measurements: dispersion index (DI), peak pressure index (PPI), and total contact area (CA). The angle of trunk tilt was also measured. Results. The majority of movements yielded less than 25% reduction in interface pressure compared to normal sitting. Reaching forward by 150% of arm length during an adapted computer activity significantly reduced DI (P < 0.05), angle of trunk tilt (p<0.05), and PPI for both ischial tuberosity regions (P < 0.001) compared to normal sitting. Conclusion. Reaching forward significantly redistributed pressure at the seating interface, as evidenced by the change in interface pressures compared to upright sitting.

Do high frequency ultrasound images support clinical skin assessment?

High frequency ultrasound imaging has been reported as a potential method of identifying the suspected tissue damage in patients "at risk" of pressure ulceration. The aim of this study was to explore whether ultrasound images supported the clinical skin assessment in an inpatient population through identification of subcutaneous tissue damage. Skin on the heels and/or sacral coccygeal area of fifty vascular surgery inpatients was assessed clinically by tissue viability nurses and with ultrasound pre operatively and at least every other day until discharge. Images were compared to routine clinical skin assessment outcomes. Qualitative classification of ultrasound images did not match outcomes yielded through the clinical skin assessment. Images corresponding to 16 participants were classified as subgroup 3 damage at the heels (equivalent to grade 2 pressure ulceration); clinical skin assessment rated no heels as greater than grade 1a (blanching erythema). Conversely, all images captured of the sacral coccygeal area were classified as normal; the clinical skin assessment rated two participants as grade 1b (non-blanching erythema). Ultrasound imaging is a potentially useful adjunct to the clinical skin assessment in providing information about the underlying tissue. However, further longitudinal clinical assessment is required to characterise images against actual and "staged" pressure ulceration.

Reviewing the literature on the effectiveness of pressure relieving movements.

Sitting for prolonged periods of time increases seating interface pressures, which is known to increase the risk of developing pressure ulcers. Those at risk of developing pressure ulcers are advised to perform pressure relieving movements such as "pushups" or "forward leans" in order to reduce the duration and magnitude of pressure acting on the vulnerable ischial tuberosity region. The aim of this review was to synthesize and critique the existing literature investigating the effectiveness of pressure relieving movements on seating interface pressures. The twenty-seven articles included in this paper highlight the need for further research investigating the effect of recommended pressure relieving movements on the pressures around the ischial tuberosities. Furthermore, this review found that the majority of individuals at risk of developing pressure ulcers do not adhere with the pressure relieving frequency or magnitude of movements currently recommended, indicating a need for pressure ulcer prevention to be explored further.

Establishing best practice in seating assessment for children with physical disabilities using qualitative methodologies.

PURPOSE: To identify best practice in children's seating assessment in the UK and Ireland. METHOD: The researchers observed six children's seating assessments performed by four therapists at three regional centres, to capture routine seating assessment practice. Observed assessment components were recorded on an 83-item checklist derived from existing published literature, and supported by video-recording. A Delphi technique obtained opinions on best practice seating assessment from seven expert therapists using three rounds of questionnaires. Themes were rated by respondents on 'importance', 'desirability' and 'feasibility'. Consensus of 70% was sought on all rated sub-themes. OBSERVATION: two assessment items (problem identification and prescription) were observed on every occasion. All other items occurred zero to five times. Standardised assessment methods were not observed. Delphi: themes identified were 'assessment process', 'assessment approach' and 'broader issues'. Consensus was reached on importance and desirability of 'assessment process' and 'assessment approach' sub-themes. CONCLUSIONS: Variation in seating assessment practice occurred between regions, yet there was agreement on theoretical best practice components. This may reflect the complexity of seating assessment in reality. The need for, and benefits of, a consistent approach was clearly identified. Future research should be directed toward developing a best practice assessment tool, which links assessment findings to appropriate seating solutions.

The use of pressure and silicone in hypertrophic scar management in burns patients: a pilot randomized controlled trial.

This pilot study investigates whether pressure and silicone therapy used simultaneously are more effective in treating multiple characteristics of hypertrophic scars than pressure alone. A pilot randomized controlled trial was conducted. Twenty-two participants with hypertrophic burn scars were randomized to receive Jobskin pressure garments and Mepiform silicone sheeting or Jobskin pressure garments alone. The Vancouver Scar Scale (VSS) was used to measure multiple scar characteristics at baseline, week 12, and week 24. No statistically significant difference was found in the rate of change of the VSS scores between the pressure therapy (PT) group and the pressure therapy and silicone group at week 12 or week 24; however, the mean scores of both groups reduced over 24 weeks. There were no statistically significant changes in the VSS subscores (scar height, vascularity, pliability, and pigmentation) from baseline to week 12 or week 24. A statistically significant relationship was observed between the VSS score and TBSA burned (<30%) in the PT group at baseline (P<.05), over 12 weeks (P<.05), and over 24 weeks (P<.05). Given the limitations of this study, especially the small sample size, further research is necessary before any firm conclusions can be drawn on this therapy approach. However, this pilot study has discussed the recurring issues in the research regarding these controversial treatments and has yielded potential for further investigation in a fully powered randomized controlled trial.

Effectiveness of training on the community skills of children with intellectual disabilities.

BACKGROUND: Children with intellectual disabilities often have difficulties in daily tasks, requiring training to increase functional independence. This study measured the effectiveness of community skills training in a telephone task and a shopping task, and examined if community-based training was more effective than classroom-based training. MATERIAL AND METHODS: A randomized control trial with 40 children aged 9-11 years was completed. Intervention groups attended an eight-week training programme; the control group received no treatment. One intervention group practised skills in local shops. All participants were assessed before and after treatment in a shopping task and telephone task, using task analysis methodology. RESULTS: Data showed a highly statistically significant difference between intervention and control groups in the shopping task (p=0.007); however, there was no significant difference between classroom and classroom supplemented by community-based learning in the shopping task. There was no significant difference between the intervention and control groups in the telephone task. CONCLUSION: Results suggested that skills training was effective in one of the skill areas with this client group. Further research is required to determine if community-based training is more effective than classroom-based learning.

Impact of sitting time on seat-interface pressure and on pressure mapping with multiple sclerosis patients.

OBJECTIVE: To examine changes in seat-interface pressure with multiple sclerosis (MS) patients. DESIGN: Case series. SETTING: Multiple Sclerosis Society's Resource Centre and community. PARTICIPANTS: Convenience sample of 15 MS wheelchair users and 12 MS non-wheelchair users. INTERVENTION: Interface pressure was measured for 8 minutes using the Force Sensing Array pressure mapping system. MAIN OUTCOME MEASURES: Number of activated sensors, standard deviation, average and maximum pressures. RESULTS: With the wheelchair users, significant decreases were found in the standard deviation and average and maximum pressures during 0 to 2 minutes of sitting ( P <.01). Average pressure was the only parameter to show a significant decrease in the non-wheelchair users ( P <.01) during 0 to 2 minutes. Significant increases were found in all output parameters during 2 to 4 minutes with both groups ( P <.05). Non-wheelchair users showed no significant changes in the output parameters after 4 minutes, but wheelchair users showed significant continued increases in the output parameters from 4 to 8 minutes ( P <.05). CONCLUSIONS: Because no significant changes in interface pressure occurred after 4 minutes of sitting with the non-wheelchair users, 4 minutes may be a reasonable sitting time before interface pressure is recorded with this group. Significant changes in interface pressure continued up to 8 minutes with the wheelchair users, therefore 8 minutes or beyond may be a reasonable sitting time before recording with this group.

Seat-interface pressure: a pilot study of the relationship to gender, body mass index, and seating position.

OBJECTIVES: To investigate the relationship between interface pressure and gender, body mass index (BMI), and seating positions, and to evaluate the implications for clinical practice. DESIGN: Group design. SETTING: Pressure mapping laboratory. PARTICIPANTS: Sixty-three student volunteers (44 women, 19 men; mean age, 22.2+/-5.1y). INTERVENTIONS: Seated-interface pressure was measured using the Force Sensing Array pressure mapping system. Seating positions used included recline (10 degrees, 20 degrees, 30 degrees ), foot support, and foot elevation. MAIN OUTCOME MEASURES: Interface pressure in the form of both average pressure (mean of the pressure sensor values) and maximum pressure (highest individual sensor value). RESULTS: Both average and maximum pressures were independent of gender, while average pressure had a significant positive correlation with BMI (r=.381, alpha=.01 level). Recline of the chair by 30 degrees significantly reduced average pressure (P<.001), whereas recline by 10 degrees or 20 degrees had no significant effect. Recline by 10 degrees, 20 degrees, and 30 degrees did not significantly alter maximum pressure. Elevation of the feet on a footstool reduced average pressure to a level approaching statistical significance, while supporting participants' feet versus leaving them unsupported significantly increased average pressure at a 0 degrees, 10 degrees, 20 degrees, and 30 degrees recline (P<.01) and maximum pressure at 0 degrees, 10 degrees (P<.01), and 30 degrees (P<.05). CONCLUSIONS: Elevating clients' feet and reclining their chair by 30 degrees reduced interface pressure and the associated risk of pressure ulcer development. Additional research is required, however, to replicate this study with participants at increased risk of pressure ulcer development.