Pressure injuries in individuals with spinal cord injury (SCI) who use wheelchairs are one of the most dangerous secondary health problems encountered during the lifespan. A key component for the prevention of pressure injuries is education to increase in-seat movement to minimize prolonged pressure under the sacral, ischial, and sacrococcygeal areas. However, the continued patient and health care system burden of pressure injuries underscores a disconnect between education and the essential practice of movement-related health behaviors. Movement is a modifiable risk factor in this population, but the field lacks effective strategies to best motivate movement. New strategies that couple the use of pressure interface mapping and movement detecting sensors, combined with existing smartphone technology can provide the right type of feedback to improve in-seat movements. By providing the right tools, we can impact individual's self-efficacy, or confidence in their ability, to perform the necessary movements to prevent pressure ulcers. Our ultimate goal is to reduce the incidence of pressure injuries by providing an effective strategy so that individuals can better self-manage their skin health. If successful, this could significantly reduce the related burden to the individual, caregivers, and the healthcare system. The objective of this project is to further develop two novel personal-use technologies (Aim 1) that provide effective feedback to increase movement to prevent pressure injuries. Next, we will test the usability of the advanced systems (Aim 2). Finally, we will evaluate how well each separate system plus a combined system impacts in-seat movement while also assessing self-efficacy related to completing recommended weight shifts (Aim 3). By comparing self-efficacy scores with changes in movement, we can begin to determine which system or combination of systems best meets individual needs. This knowledge can directly impact clinical practice and facilitate individualized care for preventing pressure injuries in wheelchair users. The central hypothesis is that compensatory feedback, provided through the right personal-use technologies, will increase in-seat movement of wheelchair users. The rationale for this project is based on solid evidence that when patients are engaged and empowered with the right tools and have improved self-efficacy for health behaviors, they are able to manage their health with far greater success.

Public Health Relevance

Sitting-related pressure injuries continue to prevail as a dangerous secondary condition among wheelchair users. Advancing the development of effective, personal-use, smartphone-based technology that allows wheelchair users to self-monitor their own seating pressure and in-seat movement patterns will provide an effective tool to prevent development of many pressure injuries. This technology will build self-efficacy for self- management of skin health in wheelchair users.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Special Emphasis Panel (ZRG1)
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Salive, Marcel
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Mayo Clinic, Rochester
United States
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