Factors influencing optimal seating pressure after spinal cord injury

Study design: Retrospective, cross-sectional design. Objectives: To identify factors that predict unsatisfactory seating pressure in spinal cord-injured (SCI) individuals. Setting: Seating Clinic at the University Hospital, Norway. Methods: All wheelchair users with traumatic SCI hospitalized between 1 January 2007 and 31 December 2010 were included. Individual assessment by a team was performed. To measure seating pressure, a computerized seating pad with sensing points 40 x 40 cm was used. Primary end points were defined as satisfactory or unsatisfactory seating position based on measured pressure (more or less 100 mm Hg), clinical findings and physical activity level. To explore possible risk factors for high seating pressure, both univariate and multivariate regression analysis were performed. Results: A total of 75 persons with SCI were assessed, 39 (52%) with unsatisfactory result. Statistical analysis revealed that use of manual wheelchair (odds ratio (OR) = 6.86, confidence interval (CI) 1.77-26.63) and history of pressure ulcer (OR = 8.47, CI 2.46-29.13) significantly increase the risk of unsatisfactory seating pressure. Paraplegia caused significantly higher risk (OR = 2.5, CI 0.99-6.34) in the univariate model, probably because the SCI with tetraplegia do prefer electrically powered wheelchairs. Conclusions: Use of manually driven wheelchairs and persons with previous pressure ulcer are at significant risk of high seating pressure and consequently developing new pressure ulcers. The patients from these subcategories need close follow-up regarding seating position and prevention of pressure ulcers. Spinal Cord (2013) 51, 273-277; doi:10.1038/sc.2012.163; published online 8 January 2013