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A randomised controlled trail investigating the impact of prescribed seating in pressure ulcer prevention for nursing home residents

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The effectiveness of specialist seating provision for nursing home residents

Authors: Daly, O. Casey, J. Martin, S. Tierney, M. O. McVey

Background
Recent statistics for nursing home admissions showed that there were 264 residential homes for elderly people in Northern Ireland providing 4,932 places (Northern Ireland Executive, 2010).
Few studies have reported the use of postural management programmes and the research based evidence supporting this practice has been limited. Clinical practice and decision making have generally depended on expert opinion combined with individual practitioner experience and preferences.
Current expenditure by the NHS in the UK on pressure ulcers is £2.1bn annually. This equates to approximately £10,500 per ulcer. Anecdotal evidence suggests that correct seating provision is instrumental in depleting this cost by preventing ulcers through investment in chairs before ulcers develop (Bennett, 2004).

Purpose of study

The purpose of this study was to try to identify the importance of suitable seating provision in reducing postural difficulties with regards swallowing, eating, breathing and feeding, and the postural management of adults in nursing homes.
Through the provision of individually prescribed seating we hope to reduce the incidence of pressure ulcers on residents within nursing homes and facilitate increased quality of life and functioning for these residents.

Methods
Study Design:
This study was a quasi-randomised controlled trial with two arms. Mixed methods using both qualitative and quantitative tools were employed.
Groups:
Forty participants were recruited from three local nursing homes.
Twenty allocated to control group – remain in existing seating system for 12 week trial period. Twenty allocated to intervention group – receive and sit in an individually prescribed seating system from Seating Matters chairs.
Outcome measures were completed with all participants at baseline and again on completion of the 12 week trial period.

Conclusion
There were a number of improvements evident in the intervention group which were not present in the control group. These results suggest that the prescription of individually tailored seating systems can

1) reduce the risk of pressure ulcers developing;

2) Increase saturated oxygen levels and thereby potential tissue nutrition;

3) reduce the number of times residents needed repositioned by caregivers;

4) increase social interaction with some individuals;

5) reduce need for lap belts and pain medications. Subsequently, residents experienced less health related problems and they were able to initiate and/or participate in more social activities.

 

Further caregiver burden of moving and handling was greatly reduced which results in important time and cost savings which can be redirected into other aspects of caregiving for these residents. The needs of each patient are different and individualised evaluation and prescription of the most suitable seating system is warranted by appropriately trained occupational therapists.

Results:
40 participants recruited, 36 participants completed (18 in intervention group and 18 in control group).

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