Abilee Kellett & Rhaya Howich

Construction Reliability of a Locally-Sourced Pressure-Reducing Wheelchair Cushion for Less-Resourced Settings

Authors: Abilee Kellett, Rhaya Howich, Emma Smith, & Dr. William Miller.

Background. In developing countries, 80% of people with spinal cord injuries die from pressure ulcer complications. Appropriately prescribed and constructed wheelchair cushions help to mitigate the occurrence of pressure ulcers. The Tuball cushion, constructed using inexpensive and locally-sourced materials, has been shown to have similar pressure-reducing properties as the ROHO cushion, providing an accessible option for low-income wheelchair users in less-resourced settings. The ecological validity of the Tuball cushion depends on the consistency of its construction, which until now, had not been explored. Aim. The purpose of this study is to assess the reliability of pressure-reducing properties across multiple Tuball cushions when independently constructed by different individuals, given equivalent materials and instructions. Mental workload demands of cushion construction will also be assessed. Method. Eleven participants were included in this study, and randomly assigned to one of two groups. In the first group, six occupational therapy (OT) students independently constructed a Tuball cushion, using equivalent instructions and materials. Following cushion construction, the six OT students each completed the NASA Task Load Index for subjective workload assessment. Each of the five OT  students in the second group sat on all six Tuball cushions, and Force Sensing Array (FSA) pressure mapping values were obtained and compared. FSA data were analysed for a primary outcome measure, dispersion index, and three secondary outcome measures, peak pressure index, contact area-quartile, and seat pressure index. Intraclass correlation coefficients (ICC’s) and 95% confidence intervals were calculated for each outcome measure. Practice Implications. The provision of a reduced-cost, locally-sourced wheelchair cushion has potential to address a critical gap in health care for wheelchair users in less-resourced areas. This study contributes to seating and mobility literature by expanding our understanding of the pressure-reducing qualities of a wheelchair cushion created from inexpensive and accessible materials. Further research is warranted to ensure Tuball cushions can be safely and effectively constructed in less-resourced settings.