PosterPDF Available
Title: A potential new solution for postural management of bedbound patients?
Summary (50 words max)
The development of pressure ulcers in bed-bound patients is an increasing problem. Use of a
pressure reducing postural sleep system has the potential to impact healthcare and long-term
patient management. Further consideration should be given to the impact of sleep posture on
tissue health and musculoskeletal management.
Aims and Objectives (70 words max)
This study aimed to measure contact pressures at the shoulders and hips during side and supine
lying, with and without a postural correction sleep system amongst healthy participants, and
gather subjective feedback relating to the support and comfort of the postural correction sleep
system.
(44 words)
Background, methods & results (500 words max)
The most commonly reported medical complication for bed-bound individuals are pressure ulcers
(Pouyan et al, 2013). Immobile patients, unable to reposition independently place their skin and
tissues under prolonged stress, restricting blood flow and oxygen/nutrient delivery, leading to cell
and tissue degradation. The annual economic burden of pressure ulcers is 1.42.1 billion pounds
(McInnes et al, 2012). Pressure ulcers are now commonly viewed as patient harm and are thought
to form due to lack of patient care. Within the NHS there is accountability for the development
of a pressure ulcer, and as such staff regularly reposition patients. However, there is no formal
guidance on patient positioning, therefore there are inconsistences amongst health care
professionals as to what is considered best practice in patient positioning. Ineffective patient
positioning can result in the worsening of muscle imbalance and body deformities such as
contractures, reducing body form and tone; an aspect of patient care that has little accountability
(Hill and Goldsmith, 2010).
Patient positioning and postural care should be used to promote optimal recovery amongst bed-
bound patients (Scottish Intercollegiate Guidelines Network, 2010: Intercollegiate Stroke Working
Party, 2016). Benefits of patient positioning include improved quality/volume of sleep,
maintenance of body shape/form, and the reduction/prevention of pressure ulcers and respiratory
problems. The development of an effective postural correction sleep system that both reduces
pressure and improves patient positioning has huge potential for both patients and health care
services. A new postural correction sleep system (Hugga ™) aims to provide effective postural
support during bed rest, that is easy to apply for the carer without compromising patient care. It
aims to reduce the risk of developing body shape distortions due to limited mobility amongst
numerous patient groups, including but not limiting to Stroke, Multiple-Sclerosis, Cerebral-Palsy,
Motor-Neuron-Disease, Duchenne, Spinal Muscle Atrophy, Catastrophic brain injury,
Fibromyalgia, Dementia and Down’s Syndrome.
Fifteen healthy participants (aged 18-50, 10 female, 5 male were screened and recruited using
modified Red Flags. The Conformat (Tekscan, USA) system was used to analyse contact pressure
under the shoulder/back and hip/buttocks. The system (Hugga ™, UK) was placed over the
mattress and pressure sensors. Contact pressure was recorded for ten minutes with/without the
postural correction sleep system, in a supine and side-lying semi-foetal position. Participants were
then asked questions relating to the comfort/restrictiveness (Numerical Rating Scales) of the
postural correction sleep system. Outcome measures of the pressure data were mean and peak
contact pressure (kPa). Repeated measures ANOVA with post-hoc pairwise comparisons was
performed. For non-parametric data (NRS) Friedman tests were performed.
In side-lying, mean and peak contact pressure at the hip reduced significantly with the postural
sleep system (p = 0.000) but significantly increased at the shoulder (p = 0.037). In supine-lying
mean and peak contact pressure at the shoulder significantly reduced with the postural correction
sleep system (p = 0.000). No significant differences were found at the hip/buttocks during supine-
lying. NRS scores revealed that even though participants felt significantly more restricted with the
postural correction sleep system in place, comfort was not compromised.
(499 words)
Discussion (250 words max)
The postural corrective sleep system used within this study held users in a specified posture (side-
lying or supine) effectively, without compromising comfort. Findings suggest, potential benefits
of reduced pressure at the shoulders in supine-lying and at the hip in side lying when using the
system, therefore potentially reducing the risk of pressure ulcer formation. A postural corrective
sleep system that is suitable for use within a community and health care setting that maintains body
shape/form and reduces risk of pressure ulcers could reduce the economic burden of pressure
ulcers and health implications associated with poor patient positioning, enhance patient care and
also reduce risks to care givers associated with manual handling techniques commonly used in the
repositioning of a patient.
Further research is required to explore how vast current practices are in patient positioning and
how effective current practices are. An exploration into the associated costs to the NHS of
preventable postural deformities amongst bed-bound patients who require additional treatment
and care as a result of poor positioning by care givers. With regards to the postural corrective
sleep system, as a result of the initial positive finding, further research is warranted to investigate
the effectiveness of the system over longer time periods, amongst specific patient groups. Long
term impacts on quality of life, posture and tissue health benefits should also be explored.
(222 words)
References
Hill, S. and Goldsmith, J. (2010) ‘Biomechanics and prevention of body shape distortion’,
Tizard Learning Disability Review, 15(2), pp. 1532.
Intercollegiate Stroke Working Party (2016) National Clinical Guideline for Stroke. 5th edn.
London: Royal College of Physicians.
McInnes, E. et al. (2012) ‘Preventing pressure ulcers-Are pressure-redistributing support
surfaces effective? A Cochrane systematic review and meta-analysis’, International Journal of
Nursing Studies. Elsevier Ltd, 49(3), pp. 345359
Pouyan, M. B. et al. (2013) ‘Continuous Eight-Posture Classification for Bed-Bound
Patients’, (Bmei), pp. 121–126.
Scottish Intercollegiate Guidelines Network (2010)
ResearchGate has not been able to resolve any citations for this publication.
Conference Paper
Pressure ulcer is a prevalent complication for bed-bound patients who are not able to shift their body weights over time. Continuous monitoring of patient's postures in the bed can be helpful for caregivers in order to keep track of patient's movements and quality of their repositioning during a day. This information allows hospitals to plan an effective repositioning schedule for each patient. In this paper, a high speed and robust posture classification algorithm is proposed that can be employed in any pervasive patient's monitoring system. First, a whole-body pressure image is recorded using a commercial pressure mat system. Image enhancement is then applied to the raw pressure images and a binary signature for each different posture is constructed. Finally, using a binary pattern matching technique, a given posture can be classified to one of the known posture classes. Our extensive experiments show that the proposed algorithm is able to predict in-bed postures with more than 97% average accuracy.
Article
Destructive changes in body shape can happen slowly over a long period of time and may affect any person who has difficulty moving efficiently, irrespective of diagnosis or age. Supporting the body in symmetrical supine lying has been found to protect and restore body shape, muscle tone and quality of life for people who would otherwise be left to become static in destructive lying postures. Those described as having complex and continuing health care needs or profound and multiple learning disabilities are likely to be at risk of developing changes in body shape. This article will consider predictable patterns of chest distortion and reduction of internal capacity of the abdomen and thorax with key characteristics for those supporting individuals at risk, non-invasive measurement of body symmetry as a relevant outcome measure in the effort to protect body shape, the consequences for individuals, their families and service providers, positive feedback from families about the benefits of night positioning, the preventable nature of changes in body shape and the practical steps that may be taken to ensure the safety of the individual. Case studies will be presented which demonstrate that the body is a mobile structure which is vulnerable to distortion but also susceptible to restoration as long as the correct biomechanical forces are applied. It is proposed that therapeutic night positioning is an effective intervention which should be made available to those at risk of body shape distortion from an early age, or as a matter of urgency for those with late onset or temporary immobility.
Article
To undertake a systematic review of the effectiveness of pressure redistributing support surfaces in the prevention of pressure ulcers. Systematic review and meta-analysis. Cochrane Wound Group Specialised Register, The Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid EMBASE and EBSCO CINAHL. The reference sections of included trials were searched for further trials. Randomised controlled trials and quasi-randomised trials, published or unpublished, which assessed the effects of support surfaces in preventing pressure ulcers (of any grade), in any patient group, in any setting compared to any other support surface, were sought. Two reviewers extracted and summarised details of eligible trials using a standardised form and assessed the methodological quality of each trial using the Cochrane risk of bias tool. Fifty-three eligible trials were identified with a total of 16,285 study participants. Overall the risk of bias in the included trials was high. Pooled analysis showed that: (i) foam alternatives to the standard hospital foam mattress reduce the incidence of pressure ulcers in people at risk (RR 0.40, 95% CI 0.21-0.74) and Australian standard medical sheepskins prevent pressure ulcers compared to standard care (RR 0.48, 95% CI 0.31-0.74). Pressure-redistributing overlays on the operating table compared to standard care reduce postoperative pressure ulcer incidence (RR 0.53, 95% CI 0.33-0.85). While there is good evidence that higher specification foam mattresses, sheepskins, and that some overlays in the operative setting are effective in preventing pressure ulcers, there is insufficient evidence to draw conclusions on the value of seat cushions, limb protectors and various constant low pressure devices. The relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear. More robust trials are required to address these research gaps.