RCT on preventing pressure ulcers with seat cushions

压力性溃疡（PU）是越来越多的美国（US）患者面临的重大医疗保健问题。 老年长期护理（LTC）居民。聚氨酯降低生活质量，导致功能毁灭性丧失， 增加老年人群的死亡风险，并增加医疗保健费用。尽管联邦预防性 在长期护理（LTC）环境中，普遍存在不遵守规定的情况。最后三个中心 医疗保险和医疗补助服务（CMS）LTC调查显示， 因未能提供适当干预以预防或治疗压疮而发出的引文数量。成本 在美国，PU的管理每年可能超过64亿美元，患病率约为 在LTC人群中占28%。有风险的老年人中坐位获得性PU的患病率估计值 人口比例为36- 50%。一些研究，包括我们自己的试点调查，支持这些 估计，并建议使用轮椅垫，旨在减少界面压力， 将降低坐姿获得性PU的发生率。尽管有这些证据， 由于尚未完成明确的研究，因此对固定和定位需求进行了常规评价， 说明为这种安排席位的干预措施提供资金的理由。因此，老年医疗保险受益人被拒绝 获得医疗上必要和临床上适当的干预措施。相反，他们最经常 配备不用于预防压疮的卷曲或分段泡沫垫。 拟议的多中心、随机减压轮椅垫试验的主要目的 （PRWC-II）是为了确定减压垫在预防坐姿获得性压力方面的功效 老年人溃疡，LTC人群。拟议试验的积极结果将提供证据水平 需要改变护理标准，包括对有风险的居民进行常规评估， 定位的需要和提供减压垫作为预防措施，防止坐- 获得性压疮如果我们的假设是正确的，这样的干预应该会导致 坐着获得性压疮的发病率和患病率，降低医疗费用， 生活质量

Pressure ulcers (PU) are a significant healthcare problem for the growing number of United States (US) elderly long-term care (LTC) residents. PU diminish quality of life, exact a devastating loss of function, increase the risk of death in geriatric populations and raise healthcare costs. Despite Federal preventive mandates for the long-term care (LTC) setting, widespread non-compliance occurs. The last three Centers for Medicare and Medicaid Services (CMS) LTC surveys showed a cumulative increase of 21% in the number of citations issued for failure to provide proper intervention to prevent or treat pressure ulcers. Costs for the management of PU in the US likely exceed $6.4 billion annually, with a prevalence of approximately 28% in the LTC population. Estimates of the prevalence of sitting-acquired PU in the elderly, at-risk population range from 36-50%. Several studies, including our own pilot investigation, support these estimates and have suggested that the use of wheelchair cushions designed to reduce interface pressure will reduce the incidence of sitting-acquired PU. Despite this evidence, eldedy wheelchair users are not routinely evaluated for seating and positioning needs bacause definitive studies have not been completed to justify funding for such seating interventions. Consequently, elderly Medicare beneficiaries are being denied access to medically necessary and clinically appropriate interventions. Instead, they are most frequently provided with convoluted or segmented-foam cushions that are not designed for pressure ulcer prevention. The primary aim of the proposed multi-center, randomized pressure-reducing wheelchair cushion trial (PRWC-II) is to determine the efficacy of pressure-reducing cushions in preventing sitting-acquired pressure ulcers in the elderly, LTC population. Positive results of the proposed trial will provide the level of evidence needed to change the standard of care to include the routine evaluation of at-risk residents for seating and positioning needs and the provision of a pressure-reducing cushion as a preventive measure against sitting- acquired pressure ulcers. If our hypothesis is correct, such an intervention should result in a decrease in the incidence and prevalence of sitting-acquired pressure ulcers, reduced healthcare costs, and improved quality of life.