Review Article

Reviewing the Literature on the Effectiveness of Pressure Relieving Movements

Table 1

Data extraction table.

AuthorAimDesignSampleActivityChair typeInterface pressure measurementOutcome measures

Bloemen-Vrencken et al., 2007 [12]To describe the health behaviour of persons with spinal cord injury(SC I) living in the community and the relationships between health behaviour, respondent/injury characteristics, and health-related variablesPostal survey QuestionnaireThe Spinal Cord Injury Lifestyle Scale (SCILS) [13]. The General Health scale of the SF-36 [14]. The Dutch questionnaire version of the Barthel Index (Post et al., 1995)

Coggrave and Rose, 2003 [15]To explore if a traditional pressure relief of 15–30 seconds was an effective pressure reliefRetrospective review Tissue oxygenation measured in sitting position (loaded) and during pressure relief (unloaded) to investigate the duration of pressure relief required for loaded TcPO2 to recover to unloaded levelsParticipants’ own wheelchairThe Oxford Pressure Monitor, (Talley Group Ltd)Time spent in pressure relief;
Transcutaneous oxygen tension

Ding et al., 2008 [16]To examine how individuals used powered wheelchair functions during typical ADLCase series Remote monitoring of daily activity 1-2 weeksParticipants’ own wheelchair with pressure relieving cushionSeating Function Data Logger (Ding et al., 2008 [16])
Force Sensory Array Pressure mapping system (Vista Medical, Winneipeg, Canada)
Seating function usage; occupancy time; frequency of tilt, recline

Field-Fote and Ray, 2010 [17]To investigate the relationships between the seated reach test, trunk excursion, and COP excursionRepeated measures (10 AB)Reach with left arm extended to the front, left, right, and back A Kisler platform with a 0.64 cm padded coverA force platform (Kisler Instrument Corp., Amherst, NY, USA)COP excursion; relationship between wrist and trunk excursion; relationship between limits of stability and COP excursion

Karataş et al., 2008 [18]To evaluate COP displacement in SCI patientsRepeated measures (18 AB)Maximum unsupported leaning forward, backward, and laterallyHard chair no backrestPliance seat sensor system (Pliance 16-P Mat, Novel, Munich, Germany)COP displacement

Kerr and Eng, 2002 [19]To quantify the limits of stability during a reaching task; determine the effect of foot support; reliability of using COP to test stabilityTest retest reliability  ABSeated reaching (forward, backward, and laterally)Rigid platformForce plateCOP displacement
COP velocity

Kobara et al., 2008 [20]To investigate the relation between the position of the pelvis while sitting in a chair, pressure and shear forceRepeated measures  ABParticipants sat on chair at various distances from the backrest then leant back to induce a posterior pelvic tiltChair with 5 cm foam cushion on seat and backrestPressure distribution measure (NITTA Corp. BIG MAT)Maximum pressure displacement

Lacoste et al., 2003 [21]To characterize the use of powered tilt and recline systemsQuestionnaire QuestionnaireSelf assessment of comfort/discomfort; rest; posture; functional independence; psychological functions of powered wheelchair

Lacoste et al., 2006 [22]To establish the validity and reliability of a pressure mapping system to measure seated postural control in childrenConcurrent validity and reliability  ABReach forward and to the right and press a button set 130%  × arm length (acromion process to tip of middle finger)Simulator chairForce Sensory Array Pressure mapping system (Vista Medical, Winneipeg, Canada)
Force plate (AMTI OR6-7)
COP displacement

Linder-Ganz et al., 2007 [23]To measure the frequency of postural changes among healthy subjects sitting in a wheelchair, and the extent of trunk motion during postural changesRepeated measures
AB
90-minute sitting period watching moviesA standard wheelchair (“Patriot”, Invacare Co. USA). No additional cushions. No special adjustmentsPressure sensors (Flexiforce, Tekscan Co. MA, USA)Movements performed in the sagittal and frontal planes

Makhsous et al., 2007 [24]To investigate the relieving effect on interface pressure of an alternate sitting protocol involving a sitting posture that reduces ischial supportRepeated measures (20 AB)Two 1 hr protocols. Normal sitting with wheelchair push ups once every 20 minutes. Normal sitting and support over ischial area removed every 10 minutesIntelligent Pressure Ulcer Prevention Cushion seating systemXsensor pressure mapping system (Xsensor Technology Corp., Calgary, Canada)Total contact area; average pressure; maximum pressure;

Makhsous et al., 2007 [25] To study the effect on tissue perfusion of relieving interface pressure using standard wheelchair push ups compared with a mechanical automated dynamic pressure relief systemRepeated measures (20 AB)Two 1 hr protocols. Normal sitting with wheelchair push ups once every 20 minutes. Normal sitting and support over ischial area removed every 10 minutesIntelligent Pressure Ulcer Prevention Cushion seating systemXsensor pressure mapping system (Xsensor Technology Corp., Calgary, Canada)Total contact area; average pressure; maximum pressure; tissue perfusion

Maurer and Sprigle, 2004 [26]To examine the effect of increasing posterior seat inclination on seating interface pressuresRepeated measures Sitting in the simulator chair in four different angles of seat inclinationKISS seat simulator (Invacare Corp, Elyria, OH)Force Sensory Array Pressure mapping system (Vista Medical, Winneipeg, Canada)Total force; contact area; peak pressure index; dispersion index

Moes, 2007 [27]To investigate the variation in sitting pressure distribution and location of the points of maximum pressure with rotation of the pelvis, gender, and body characteristicsRepeated measures Forward and backward rotation of the pelvisKistler platformA pressure measuring device [28]. A mirror box [29].
A small antenna attached to the sacrum
Pelvis rotation; location of the points of maximum pressure; pressure distribution; pelvic angle

Olsson et al., 2008 [30]To investigate whether pressure mapping can be used as a compliment in sitting analysis and to study the test retest reliability of the measurementsConcurrent validity and reliability  ABReach 1.5 × arm length to either side and forwardWooden BenchForce Sensory Array Pressure mapping system (Vista Medical, Winneipeg, Canada)COP displacement

Parkinson et al., 2006 [31]To obtain normative data on COP excursion capability for lateral reachesRepeated measures  ABMaximal lateral reachesRigid platformXsensor pressure sensing mat (Xsensor, Technology Corp., Calgary, Canada).
Force plate (OR6-5-1, AMTI, Watertown, MA, USA)
Maximum COP excursion capability

Reenalda et al., 2009 [32]To describe healthy dynamic sitting behaviour and investigate the effects of sitting behaviour on subcutaneous tissue oxygenationCross-sectional study  AB 60-minute sitting period watching TVWheelchairTekscan CONFORMat pressure mapping device (Tekscan Inc, Boston, MA, USA) Frequency of posture shifts and impact on subcutaneous tissue oxygenation

Sonenblum et al., 2009 [33]To monitor and describe the use of powered wheelchairs in everyday life and record the frequency of pressure relieving movementsCase series Remote monitoring over 1-2 weeksParticipants’ own wheelchair with pressure relieving cushionThe Wheelchair Activity Monitoring Instrument [34]. Uniaxial accelerometer (VTI Technologies, Finland)Daily wheelchair occupancy; typical position; time spent in small, medium and large tilt; tilt frequency and pressure relieving frequency

Sonenblum and Sprigle, 2011 [35]To evaluate the biomechanical responses to full body tilt in persons with SCIRepeated measures Sitting in wheelchair at various degrees of tiltParticipants’ own wheelchairA custom sensor (Vista Medical, Winneipeg, Canada)Average pressure
Maximum pressure

Sonenblum and Sprigle, 2011 [36]To characterise the use of powered wheelchairsCase series Remote monitoring over 1-2 weeksParticipants’ own wheelchair with pressure relieving cushionThe Wheelchair Activity Monitoring Instrument [34]. Uni axial accelerometer (VTI Technologies, Finland)Daily wheelchair occupancy; typical position

Sprigle et al., 2010 [37]To provide quantitative information on the magnitudes of loading on the body across clinical ranges of tilt, recline, and standingRepeated measures  (6 AB)Sitting in wheelchair in various degrees of tilt, recline, and standingLevo combi power wheelchair (Levo USA, Brooklyn Park, MN, USA)Tekscan Pressure Sensor System (CONFORMAT 5315QL; TEKSCAN, Boston, MA, USA)Rates of unloading and
maximum loading

Stinson et al., 2003 [38]To investigate the relationship between interface pressure and gender, BMI, and seating positionsGroup design  ABSitting in armchair set at 10°, 20°, and 30° recline with and without foot supportArmchairForce Sensory Array Pressure mapping system (Vista Medical, Winneipeg, Canada)Average pressure
Maximum pressure

Stockton and Parker, 2002 [39]To provide an insight into wheelchair users preventative health behaviours/ pressure relief behavioursPostal questionnaire QuestionnairePostal Questionnaire: self assessment of physical capability, past frequency of pressure relieving movements, perceived risk, attribution of responsibility for the performance of pressure relief, and other preventative behaviours

Van Geffen et al., 2008 [40]To investigate the effects of postural adjustments on seat reaction loadRepeated measures  ABParticipants sat in simulator chair which passively moved their pelvis posteriorly and reclined backAdjustable simulator chairTekscan Pressure Sensor System (CONFORMAT 5315QL; TEKSCAN, Boston, MA, USA)Average pressure (ischial and sacral) and centre of pressure

Van Geffen et al., 2009 [41]To investigate the effects of decoupled pelvis rotation on seating interface loadsRepeated measures  ABParticipants sat in simulator chair which passively moved their pelvis posteriorly and side to sideAdjustable simulator chairTekscan Pressure Sensor System (CONFORMAT 5315QL; TEKSCAN, Boston, MA)Pelvis orientation; seat reaction force; centre of pressure; peak pressure index and sacral load

Vos et al., 2006 [42]To investigate personal, postural and design factors upon seating interface pressuresRepeated measures Each participant sat in each of the chairs12 ergonomic office chairsXsensor pressure mapping system (Xsensor Technology Corp., Calgary, Canada)Average and maximum pressure

Yang et al., 2009 [43]To describe the sitting behaviours in community-dwelling manual wheelchair users (MWUs) with spinal cord injury (SCI)Case series study 1 week normal activities of daily livingParticipants’ own wheelchairs6 force sensor resistors (interlink electronics, Camarillo, CA, USA)Lift off frequency
Cumulative sitting time