Abstract
OBJECTIVE: To describe differences in in-seat behavior observed between individuals with a spinal cord injury (SCI) with and without a history of recurrent pressure injuries. DESIGN: Cross-sectional cohort study. SETTING: General community. PARTICIPANTS: Twenty-nine adults more than 2 years post SCI, who used a wheelchair as their primary mobility device and had the ability to independently perform weight shift maneuvers. Participants were grouped according to whether or not they had a history of recurrent pressure injuries (PrIs), with 12 subjects having had two or more pressure injuries in the pelvic area (PrI Group). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Daily time in wheelchair, number of transfers, and frequency of pressure reliefs (full unloading), weight shifts (30% load reduction), and in-seat movements (transient center of pressure movements or unloading). RESULTS: The median participant spent 10.3 hours in his wheelchair and performed 16 transfers to or from the wheelchair daily. Pressure reliefs were performed less than once every 3 hours in both groups. Weight shifts were performed significantly more often by the No PrI Group (median (interquartile range) 2.5 (1.0-3.6) per hour) than the PrI Group (1.0 (0.4-1.9), with P = 0.037 and effect size r = 0.39). In-seat movements were performed 46.5 (28.7-76.7) times per hour by the No PrI group and 39.6 (24.3-49.7) times per hour for the PrI group (P = 0.352, effect size r = 0.17). CONCLUSION: Weight shifts that can be produced by functional activities and that partially unload the buttocks should be considered as an important addition to individuals' PrI prevention regimen.