Clinical Use of Interface Pressure to Predict Pressure Ulcer Development: A Systematic Review

Abstract

Pressure ulcers are a large problem in subjects who use a wheelchair for their mobility. These ulcers originate beneath the bony prominences of the pelvis and progress outward as a consequence of prolonged pressure. Interface pressure is used clinically to predict and prevent pressure ulcers. However, the relation between interface pressure and the development of pressure ulcers is not clear. A systematic review was performed to address the research question of whether interface pressure can be used to predict the development of pressure ulcers or to determine the prognosis of an ulcer once developed. Seven studies were identified that measured interface pressure and used the development or healing of pressure ulcers as an outcome measure. There appears to be a weak qualitative relation between interface pressure and the development of pressure ulcers. However, no conclusive clinical threshold for the interface pressure can be given. This, combined with the influence of individual characteristics, the low internal validity of interface pressure measurement for the prediction of pressure ulcers, and an incongruent relation between pressure magnitude and duration, results in the fact that no quantification of the predictive or prognostic value of interface pressure can be given.

Analysis of healthy sitting behavior: Interface pressure distribution and subcutaneous tissue oxygenation

“…The DI has been proposed as a relative measure to describe the distribution of pressure on the tuberal regions compared with the total contact surface and has been shown to have good reliability [24]. A weak qualitative relation appears to exist between interface pressure and the development of pressure ulcers [8]. As a result, no conclusive clinical threshold for the interface pressure can be given.…”

“…Furthermore, the measurement of interface pressure has low internal validity for the prediction of pressure ulcers and an incongruent relation exists between pressure magnitude and duration. This results in the fact that no quantification of the predictive or prognostic value of interface pressure can be given [8]. To overcome this problem, the present study used the measurement of subcutaneous tissue perfusion and SO 2 with the O2C.…”

“…Despite the fact that much research has been performed on the etiology and prevention of pressure ulcers, a threshold value for the development of deep pressure ulcers, in terms of magnitude or duration, is still lacking. Moreover, the relation between interface pressure and the probability of pressure ulcer development is not consistent [8]. In addition, the developed pressure time curves predict that pressure ulcers will develop eventually, even with optimal pressure distribution [9][10].…”

Assessing evidence supporting redistribution of pressure for pressure ulcer prevention: A review

“…Researchers have shown tha t high seated interface pressures were associated with PU occurrence [17][18][19]. Therefore, despite the limita tions in IPM as a less accurate representation of localized loading [5,[20][21][22], it can be useful in selecting cushions.…”

Back to basics: biophysical methods in tissue viability research

“…Tissue viability under compression depends not only on the magnitude of mechanical loads but also on the time of exposure to loads (Gefen, 2007). With this in mind, pressure measurements alone is not sufficient to alert the clinician to potential areas of tissue breakdown (Reenalda et al, 2009).…”