For long‑term wheelchair users, switch to a pressure‑relieving cushion and check the ischial and sacrococcygeal areas daily

Regular foam cushions can cause skin breakdown after prolonged pressure. Once broken, the skin heals slowly and is prone to infection. In a trial conducted in nursing homes, the group using pressure‑relieving cushions showed significantly fewer pressure ulcers on the ischial region. Wheelchairs must also be sized to each individual; a generic model does not suffice.

A pressure‑relieving cushion costs several hundred to over a thousand yuan. The daily check takes just one minute.

This randomized clinical trial took place in 12 nursing homes between 2004 and 2008, enrolling 232 residents aged 65 or older who used a wheelchair for at least 6 hours daily and had a Braden score ≤18. All participants received a properly fitted wheelchair and were then randomly assigned to two groups: one used skin‑protective cushions (air, viscoelastic fluid plus foam, or gel plus foam), while the other used segmented foam cushions 7.6 cm thick. Follow‑up lasted 6 months or until a pressure ulcer developed. For pressure ulcers at the ischial tuberosity, the segmented foam group had 8 cases (6.7%) versus 1 case (0.9%) in the skin‑protective group (P = 0.04). When both ischial and sacrococcygeal ulcers were counted, the segmented foam group had 21 cases (17.6%) and the skin‑protective group 12 cases (10.6%); this difference was not statistically significant (P = 0.14).

Two factors justify a B rating. First, the sample size was only 232 participants; the P‑value for the primary outcome (0.04) barely crossed the threshold, while secondary outcomes showed no difference. Second, the participants were elderly nursing‑home residents; results may not apply to younger wheelchair users. Since all subjects received a properly fitted wheelchair, both “proper fit” and “cushion type” contributed to outcomes; therefore, merely swapping the cushion is insufficient. For pressure‑ulcer prevention in bedridden individuals, air mattresses and regular repositioning are discussed in Section 17, Item 8 (Pressure ulcers). Information on applying for subsidies for basic assistive devices can be found in Section 7 of this chapter (contact the county disability‑services office).

Brienza D, Kelsey S, Karg P, et al. (2010). A randomized clinical trial on preventing pressure ulcers with wheelchair seat cushions. Journal of the American Geriatrics Society, 58(12):2308-2314. https://doi.org/10.1111/j.1532-5415.2010.03168.x