6 2012day1 comparison of pressure redistribution survaces

7/29/2019 6 2012Day1 Comparison of Pressure Redistribution Survaces

1/21

Comparison of pressure

redistribution surfaces basedon peak pressure at bony

prominences

J ohn Welsh, OT


2/21

Background

Residential and acute care

Prevention/treatment of pressure ulcers

OTs role is to address the cause which

includes the recommendation oftherapeutic surfaces


3/21

Why?

$2 million per year for rentals Length of stay and cost associated with pressure ulcers continues to rise.

80% increase in pressure ulcer occurrence in acute care hospitals from1993-2006 (Russo, 2008) Therapeutic surfaces are one of the most common interventions in

prevention and treatment of pressure ulcers. Need independent evaluation using the same subjects in the same positions

Manufacturers often display pressure maps for supine position only, if at all.For many patients this is not relevant. (Enriquez et al 2007) Pressure mapping of the same subject on the same bed frame in the same

position showed discrepancies between surfaces of the sameclass.(Enriquez et al2007)


4/21

Hypothesis:Therapeutic surfaces will

have lower peak pressures whencompared to the standard mattress

Are there differences between surfacesability to redistribute pressure?

Are some better than others?


5/21

Evidence


6/21

Literature Review

Improve QOL and healthcare efficiencies (Jenkins et al)

Heel (26%) and Coccyx (20%) most common(Jenkins et al)

We need more research comparing different supportsurfaces(McInnes et al)

Foam overlays reduce incidence of ulcers compared tostandard hospital mattress.(McInnes et al)

Evidence for effectiveness of alternating pressure mattressesand high tech therapeutic surfaces is inconclusive (McInnes etal)

Low tech dry f lotation and air f luidized systems produce similar

outcomes for prevention and treatment.(Economides et al)(Kato et al)

Active alternating therapy vs reactive devices(Malbrain et al)


7/21

Evaluation of Surfaces

Therapeutic surfaces work on the principle of redistr ibutinginterface pressure thereby permitt ing circulation to skin around

bony prominences

Pressure mapping is a reliable measure of interface

pressure(Stinson et al) Take readings between 6-10 minutes.(Stinson et al)

Calgary Pressure Mapping Protocol is being developed to lookat uniform pressure mapping standards and improve interrater

reliability (Jill ian Swaine, OT)


8/21

Relax for a second


9/21

Study Design

8 volunteers over the age of 65

8 different surfaces vs standard mattress

8 minutes before taking a reading

Position with head of bed maximally raised


10/21

Use of the Active X Sensor for pressure mapping

Peak pressure and Peak Pressure Index at the heels and sacrum

were recorded


11/21

Methodology

Recruited 8 volunteers over the age of 65 Ladies Im asking you to lend your bottoms to science

2 days 8 surfaces vs standard hospital mattress Use of loose sheet and KCI Dri Flo pad to mimic hospital

conditions Record peak pressures at coccyx and heels


12/21

Data Analysis:

Peak Pressure Index and Peak Pressurecollected for each subject on each surface at thesacrum and heels

T test and Wilcoxon rank test to compare for

significance of surface vs standard mattress


13/21

Data AnalysisMean Difference Between Standard and Therapeutic Mattresses for Peak Pressure Heel

(N=7) (Pairwise t-tests)

Control Mean SD Comparison Mean SD t-testP

value

Standard 94.35 44.69 KCI Therakair 71.52 25.04 1.43 0.21

Standard 92.46 41.11 Versacare 59.86 18.33 2.27 0.06

Standard 94.35 44.69 ROHO LAL 102.12 21.03 -0.47 0.66

Standard 92.46 41.11 ROHO OL 42.60 13.03 3.22 0.02

Standard 92.46 41.11 Geomat OL 109.30 42.66 -0.67 0.53

Standard 94.35 44.69 Vicair 82.47 18.21 0.78 0.47

Standard 94.35 44.69 Atmos Air 71.92 13.45 1.36 0.23

Standard 92.46 41.11 Isoflex 130.70 32.88 -2.16 0.08

Note. Results from nonparametric test (Wilcoxon Rank test) indicate significant differencesbetween the standard mattress and Versacare (p=.03) and ROHO OL (p=.02). Both are showing

lower means compared with the standard. P value between the standard mattress and Isoflexp =

.09.


14/21

Data Analysis Heel Peak Pressure

Mean Difference Between Standard and Therapeutic Mattresses for Peak Pressure Sacrum

(N=8) (Pairwise t-tests)

Control Mean SD Comparison Mean SD t-testP

value

Standard 73.93 22.23 KCI Therakair 84.87 14.29 -1.02 0.35

Standard 73.80 20.58 Versacare 78.89 13.55 -0.59 0.58

Standard 75.75 23.77 ROHO LAL 69.30 11.22 0.50 0.64

Standard 73.80 20.58 ROHO OL 90.19 14.46 -1.81 0.11

Standard 73.80 20.58 Geomat OL 80.68 14.22 -0.71 0.50

Standard 75.75 23.77 Vicair 85.00 8.87 -0.79 0.47

Standard 75.75 23.77 Atmos Air 75.83 12.17 -0.01 0.99

Standard 73.80 20.58 Isoflex 100.78 29.98 -2.17 0.07

Note. Results from nonparametric test (Wilcoxon Rank test):p values between the standard mattress

and ROHO OL = .09and between the standard mattress and Isoflex = .07.


15/21

1.Using t-test: there was a significant mean difference for Peak Pressure Heal between

the standard mattress (M=92.46; SD=41.11) and ROHO OL mattress (M=59.86;

SD=18.33), t(6)= 2.27, p < .05.2.Using Wilcoxon test: Peak Pressure Heel for Versacare mattress (Mdn=57.7 )

differed significantly from the standard mattress (Mdn=89.7). OR: Peak Pressure Heel

for Versacare mattress (Mdn=57.7) were significantly lower than the Peak Pressure

Heel for the standard mattress (Mdn=89.7).3.No signficant change in Peak Pressure at the sacrum vs standard mattress

4.You can report the effect sizes, using Cohen benchmarks, for significant differences

(Wilcoxon test). The effect size for versacare mattress is -.59 and for ROHOL OL -

.63. Both have medium effect sizes (which is great).

Note. We report means for t-test and medians for Wilcoxon test.

Variables with border line significance (e.g, PPS for Isoflex p= .07) could become

significant with a larger sample size.


16/21

Results and Interpretation


17/21

Differences between surfaces may to be diminished with the head of thebed up and in some cases this position may create higher peak pressuresthan on a standard surface

Therapeutic surfaces may address other causes of skin breakdown such asshear(10x pressure) or friction which could not be measured eg. ROHOcells vs foam or low friction covering

The use of healthy subjects may have mitigated the effect of the surfacesdue to the presence of ahem adipose tissue and muscle compared to frailor emaciated individuals and cannot

Sample size not large enough to produce significant results Even on the most effective surface the median peak pressures at the

coccyx generated were more than double the pressure relief standard of32 mmHg capillary pressure in healthy individuals


18/21

Importance of mobilization, bed

positioning, turning and education Mattresses may create a false sense of

security

Supports NPUA recommendation thatheels should be managed separately

Larger study with patients/residents athigh risk should be done but $, time andethical considerations


19/21


20/21

Questions?


21/21

REFERENCES Enriquez, Elizabeth Limouze RN, BSN, MPH, CWOCN; Holland, Diane L. P.T., CWS, DAPWCA, CPed PRESSURE MAPPINGIT'S THE PEAK THAT COUNTS, AND ALL SPECIALTY MATTRESSES ARE NOT

EQUAL: 1356 J ournal of Wound, Ostomy and Continence Nursing Issue: Volume 34(3S) Supplement, May/J une

2007, p S54 Economides NG; Skoutakis VA; Carter CA; Smith VH Evaluation of the effectiveness of two support surfacesfollowing myocutaneous flap surgery.(includes abstract);; Advances in Wound Care, 1995 J an-Feb; 8 (1): 49-53(journal article - research, tables/charts) ISSN: 1076-2191 PMID: 7795873 CINAHL AN: 1995011076.

J enkins ML, O'Neal E. Pressure ulcer prevalence and incidence in acute care. Adv Skin Wound Care. 2010Dec;23(12):556-9.

Kato H., Inoue T., Torii S. EMBASE A new postoperative management scheme for preventing sacral pressure sores in patients with spinal

cord injuries. Annals of Plastic Surgery. 40 (1) (pp 39-43), 1998. Date of Publication: 1998. Malbrain M; Hendriks B; Wijnands P; Denie D; J ans A; Vanpellicom J ; De Keulenaer B; J ournal of A pilot

randomised controlled trial comparing reactive air and active alternating pressure mattresses in the prevention andtreatment of pressure ulcers among medical ICU patients.(includes abstract); Tissue Viability, 2010 Feb; 19

McInnes E, Cullum NA, Bell-Syer SEM, Dumville J C, J ammali-Blasi A. Support surfaces for pressure ulcerprevention. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD001735. DOI:

10.1002/14651858.CD001735.pub3 Stinson M, Porter A, Eakin P. Measuring interface pressure: A laboratory-based investigation into the effects of

repositioning and sitting. Am J Occup Ther 2002;56:185-190. Ebsco AtoZ [Context Link] Stinson MD, Porter-Armstrong AP, Eakin PA. Pressure mapping systems: reliability of pressure map interpretation.

Clin Rehabil. 2003 Aug;17(5):504-11. Sprigle S, Dunlop W, Press L. Reliability of bench tests of interface pressure. Assistive Technology 2003; 15:49-57
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Jenkins%20ML%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22O%27Neal%20E%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22O%27Neal%20E%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22O%27Neal%20E%22%5BAuthor%5Dhttp://ovidsp.tx.ovid.com/sp-3.3.1a/ovidweb.cgi?Link+Set+Ref=00004495-201012000-00006|00000448_2002_56_185_stinson_investigation_%7c00004495-201012000-00006%23xpointer%28id%28R21-6%29%29%7c11307149%7c%7covftdb%7c00000448-200203000-00008&P=117&S=PIPIFPGIPHDDFHOGNCCLPDLBKHMNAA00&WebLinkReturn=Full+Text%3dL%7cS.sh.76.79%7c0%7c00004495-201012000-00006http://ovidsp.tx.ovid.com/sp-3.3.1a/ovidweb.cgi?&S=PIPIFPGIPHDDFHOGNCCLPDLBKHMNAA00&Link+Set=S.sh.76%7c1%7csl_10#58#58http://ovidsp.tx.ovid.com/sp-3.3.1a/ovidweb.cgi?Link+Set+Ref=00004495-201012000-00006|00000448_2002_56_185_stinson_investigation_%7c00004495-201012000-00006%23xpointer%28id%28R21-6%29%29%7c11307149%7c%7covftdb%7c00000448-200203000-00008&P=117&S=PIPIFPGIPHDDFHOGNCCLPDLBKHMNAA00&WebLinkReturn=Full+Text%3dL%7cS.sh.76.79%7c0%7c00004495-201012000-00006http://ovidsp.tx.ovid.com/sp-3.3.1a/ovidweb.cgi?Link+Set+Ref=00004495-201012000-00006|00000448_2002_56_185_stinson_investigation_%7c00004495-201012000-00006%23xpointer%28id%28R21-6%29%29%7c11307149%7c%7covftdb%7c00000448-200203000-00008&P=117&S=PIPIFPGIPHDDFHOGNCCLPDLBKHMNAA00&WebLinkReturn=Full+Text%3dL%7cS.sh.76.79%7c0%7c00004495-201012000-00006http://ovidsp.tx.ovid.com/sp-3.3.1a/ovidweb.cgi?&S=PIPIFPGIPHDDFHOGNCCLPDLBKHMNAA00&Link+Set=S.sh.76%7c1%7csl_10#58#58http://www.ncbi.nlm.nih.gov/pubmed?term=%22Stinson%20MD%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Porter-Armstrong%20AP%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Porter-Armstrong%20AP%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Eakin%20PA%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Eakin%20PA%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Eakin%20PA%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Eakin%20PA%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Porter-Armstrong%20AP%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Stinson%20MD%22%5BAuthor%5Dhttp://ovidsp.tx.ovid.com/sp-3.3.1a/ovidweb.cgi?&S=PIPIFPGIPHDDFHOGNCCLPDLBKHMNAA00&Link+Set=S.sh.76%7c1%7csl_10#58#58http://ovidsp.tx.ovid.com/sp-3.3.1a/ovidweb.cgi?Link+Set+Ref=00004495-201012000-00006|00000448_2002_56_185_stinson_investigation_%7c00004495-201012000-00006%23xpointer%28id%28R21-6%29%29%7c11307149%7c%7covftdb%7c00000448-200203000-00008&P=117&S=PIPIFPGIPHDDFHOGNCCLPDLBKHMNAA00&WebLinkReturn=Full+Text%3dL%7cS.sh.76.79%7c0%7c00004495-201012000-00006http://www.ncbi.nlm.nih.gov/pubmed?term=%22O%27Neal%20E%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Jenkins%20ML%22%5BAuthor%5D

6 2012day1 comparison of pressure redistribution survaces

Documents