Investigating the Impact of Pressure Relief Performance on the Occurrence of Pressure Injuries and Shoulder Pain in Wheelchair Users with Spinal Cord Injury (PRperf Study): Study Protocol for a Prospective Observational Study
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Study Procedures and Outcomes
2.3. Quality Assurance and Safety Provisions
2.4. Data Analysis Plan
2.5. Dissemination Policy
3. Strengths and Limitations
4. Outlook
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
AIS | American Spinal Injury Association Impairment Scale |
EKNZ | Swiss Ethics Committee for Northwest/Central Switzerland |
IMU | Inertial measurement unit |
PI | Pressure injury |
PR | Pressure relief |
PRperf | Pressure relief performance |
SCI | Spinal cord injury |
SCIM-SR | Spinal Cord Independence Measure Self-Report |
SP | Shoulder pain |
SwiSCI | Swiss Spinal Cord Injury cohort study |
WUSPI | Wheelchair User’s Shoulder Pain Index |
Appendix A
Exposure and Main Outcomes | Assessment Method | Parameter/Unit | Assessment Timepoints | Literature | |
---|---|---|---|---|---|
PR performance | Measured using a textile sensor mat (Sensomative wheelchair, Sensomative GmbH, Rothenburg, Switzerland) | PR technique (weight relief lift, forward lean, side lean, or other) PR frequency (times/h) PR duration (s) | T1+, T2+, T3+, T4+ | [30] | |
PI occurrence | Questioning | Location and grade (following National Pressure Injury Advisory Panel (NPIAP) pressure injury stages 1 to 4, including unstageable pressure injuries) | Screening, T1, T2, T3, T4, T5/Tocc | [7,46] | |
SP | Wheelchair User’s Shoulder Pain Index (WUSPI) | Score of 0 to 150 points | T1+, T2+, T3+, T4+ | [40] | |
Confounder | Assessment Method | Parameter/Unit | Assessment Timepoints | Confounder for | Literature |
Age | Questioning | Years | Screening | PI, SP | [11,12,36,47,48,49,50] |
Alcohol consumption | Questioning | Days/week and units/day | T1, T2, T3, T4, T5/Tocc | PI | [51] |
Anxiety and depression | Hospital Anxiety and Depression Scale (HADS) | Score of 0 to 21 points for anxiety and depression, respectively | T1, T2, T3, T4, T5/Tocc | PI, SP | [48,52] |
Autonomic dysreflexia | ISAFSCI questionnaire | Binary (yes/no) | T1, T2, T3, T4, T5/Tocc | PI | [10,53] |
Bed rest during daytime/day | Questioning | Hours | T1+, T2+, T3+, T4+ | PI | |
Diabetes mellitus | Questioning | Binary (yes/no) | T1, (T2), (T3), (T4), (T5/Tocc) | PI | [50,54,55] |
Feverish infection | Questioning | Binary (yes/no) | T1, T2, T3, T4, T5/Tocc | PI | [10,54] |
Height | Questioning | cm | T1 | PI, SP | |
Incontinence | ISAFSCI questionnaire | Score of 0 to 2 points | T1, T2, T3, T4, T5/Tocc | PI | [11,48,53,54] |
Independence in activities of daily life | SCIM-SR questionnaire | Score of 0 to 100 points; divisible into three subscales | T1, (T2), (T3), (T4), (T5/Tocc) | PI, SP | [10,54,55,56] |
Lesion AIS | Questioning, Medical record | Score of A to E | T1, (T2), (T3), (T4), (T5/Tocc) | PI, SP | [2,10,12,36,49,55] |
Lesion duration | Questioning, Medical record | Years since injury | Screening | PI, SP | [12,22,36,47,49,57] |
Lesion level | Questioning, Medical record | C1 to S5 | T1, (T2), (T3), (T4), (T5/Tocc) | PI, SP | [2,12,22,49,57] |
Medication intake | Questioning | Type of medication | T1, T2, T3, T4, T5/Tocc | PI, SP | [47,57] |
Menopausal status | Questioning | Binary (menopause yes/no) | T1, T2, T3, T4, T5/Tocc | PI | |
Mobility independence | SCIM-SR questionnaire—Mobility during short distances (10–100 m) | Score of 0 to 8 | Screening, T1, T2, T3, T4, T5/Tocc | PI, SP | [11,56] |
MVPA duration/week | Questioning | Hours/week | T1, T2, T3, T4, T5/Tocc | PI, SP | |
PI location | Questioning | Location | T1, T2, T3, T4, T5/Tocc | PI | [11,48,55] |
PI stage | Questioning | Stage 1 to 4 | T1, T2, T3, T4, T5/Tocc | PI | [7,11,46,48,54] |
PI treatment | Questioning | Conservative/surgical | T1, T2, T3, T4, T5/Tocc | PI | |
Pressure relief quality | Pressure mat (ForeSite SS, Xsensor, Calgary, Canada) | % of pressure compared to upright sitting | T1, (T2), (T3), (T4), (T5/Tocc) | PI | |
RoM upper extremity | Goniometer | Degrees | T1, (T2), (T3), (T4), (T5/Tocc) | SP | [22] |
Rotator cuff function | Belly-Press Test (also Napoleon-Test) | Binary (positive/negative) | T1, (T2), (T3), (T4), (T5/Tocc) | SP | [58,59] |
Self-efficacy | General self-efficacy scale | Score from 0 to 40 | T1, T2, T3, T4, T5/Tocc | PI, SP | [60,61,62] |
Sex | Questioning | Binary (male/female) | Screening | PI, SP | [2,37,49] |
Shoulder injuries | Questioning | Type of injury | T1, (T2), (T3), (T4), (T5/Tocc) | SP | [12] |
Shoulder intervention | Questioning | Type of intervention | T1, (T2), (T3), (T4), (T5/Tocc) | SP | |
Shoulder joint disease/pathology | Questioning | Type of disease/pathology | T1, (T2), (T3), (T4), (T5/Tocc) | SP | [12,22,58] |
Sitting time/day | Questioning during screening, afterwards using measurement mat (Sensomative) | Hours | Screening, T1+, T2+, T3+, T4+ | PI, SP | |
Skin check performance | Questioning | Times/week | T1, T2, T3, T4, T5/Tocc | PI | [11] |
Smoking | Questioning | Cigarettes/day | T1, T2, T3, T4, T5/Tocc | PI | [47,51,55,57] |
Spasticity lower extremities | Modified Ashworth Scale | Score from 0 to 4 | T1, (T2), (T3), (T4), (T5/Tocc) | PI | [2,48,63] |
Spasticity upper extremities | Modified Ashworth Scale | Score from 0 to 4 | T1, (T2), (T3), (T4), (T5/Tocc) | SP | [2,48,63] |
SR-PR performance | Questioning | Times/hour and seconds/PR | T1+, T2+, T3+, T4+ | PI | |
Transfer number/day | Measurement mat (Sensomative) | Times/day | T1+, T2+, T3+, T4+ | PI, SP | [11,64] |
Transfer quality | Transfer Assessment Instrument | Score from 0 to 10 | T1, (T2), (T3), (T4), (T5/Tocc) | PI, SP | [11,64,65,66] |
Weight | Measurement on a wheelchair-accessible scale, measurement of wheelchair separately from participant | kg | T1, (T2), (T3), (T4), (T5/Tocc) | PI, SP | [11,12,22,48,50,55] |
Wheelchair hip angle | Goniometer | Degrees | T1, (T2), (T3), (T4), (T5/Tocc) | PI | [12] |
Wheelchair shoulder position | Assessment | In front of hip/above hip/behind hip | T1, (T2), (T3), (T4), (T5/Tocc) | SP | [12] |
Wheelchair cushion type | Questioning | Cushion brand and model | T1, (T2), (T3), (T4), (T5/Tocc) | PI | [11,67] |
Wheelchair mobility | Wearable IMU sensor attached to wheelchair wheel (Axivity AX6, Axivity Ltd., Newcastle upon Tyne, UK) | Distance covered (km/day), linear velocity of the wheelchair (km/h), number of pushes (pushes/day), duration of pushes (s/push), number of turns (turns/day), magnitude of turns (degrees/turn) | T1+, T2+, T3+, T4+ | PI, SP | [22,39] |
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Schürch, Y.; Hertig-Godeschalk, A.; Eriks-Hoogland, I.; Scheel-Sailer, A.; Brinkhof, M.W.G.; Arnet, U. Investigating the Impact of Pressure Relief Performance on the Occurrence of Pressure Injuries and Shoulder Pain in Wheelchair Users with Spinal Cord Injury (PRperf Study): Study Protocol for a Prospective Observational Study. Methods Protoc. 2025, 8, 62. https://doi.org/10.3390/mps8030062
Schürch Y, Hertig-Godeschalk A, Eriks-Hoogland I, Scheel-Sailer A, Brinkhof MWG, Arnet U. Investigating the Impact of Pressure Relief Performance on the Occurrence of Pressure Injuries and Shoulder Pain in Wheelchair Users with Spinal Cord Injury (PRperf Study): Study Protocol for a Prospective Observational Study. Methods and Protocols. 2025; 8(3):62. https://doi.org/10.3390/mps8030062
Chicago/Turabian StyleSchürch, Yannik, Anneke Hertig-Godeschalk, Inge Eriks-Hoogland, Anke Scheel-Sailer, Martin W. G. Brinkhof, and Ursina Arnet. 2025. "Investigating the Impact of Pressure Relief Performance on the Occurrence of Pressure Injuries and Shoulder Pain in Wheelchair Users with Spinal Cord Injury (PRperf Study): Study Protocol for a Prospective Observational Study" Methods and Protocols 8, no. 3: 62. https://doi.org/10.3390/mps8030062
APA StyleSchürch, Y., Hertig-Godeschalk, A., Eriks-Hoogland, I., Scheel-Sailer, A., Brinkhof, M. W. G., & Arnet, U. (2025). Investigating the Impact of Pressure Relief Performance on the Occurrence of Pressure Injuries and Shoulder Pain in Wheelchair Users with Spinal Cord Injury (PRperf Study): Study Protocol for a Prospective Observational Study. Methods and Protocols, 8(3), 62. https://doi.org/10.3390/mps8030062