COMPARISON OF INTERFACE PRESSURE OF DIFFERENT WHEELCHAIR CUSHIONS: PHASE I STUDYABSTRACT
Objective: to compare the interface pressure in individuals sitting on six different wheelchair cushions.
Method: phase I clinical study, carried out with 37 participants in July 2024 at the Technology and Innovation Laboratory, totaling 222 evaluations. The cushions were allocated to a control group (A - air cells) and five intervention groups (B and C - polyurethane foam; D, E and F -C-CORE polyethylene). The independent variable was the type of cushion, and the dependent variable was the interface pressure. The control variables were age, sex, height, weight and hip circumference, using analysis of covariance.
Results: the mean age was 27.38 years (±SD 10.39); 56.8 % were men, mean weight 72.6 kg (160 lbs) (±SD 20); mean height 1.70 m (5.6 ft) (±SD 0.11); mean hip circumference 101.1 cm (±SD 12.6). The average pressure ranged from 3,735.1 mmHg to 5,380.8 mmHg. Multiple comparisons among groups revealed that the cushion in group A (control) presented significantly lower pressure values compared to the cushions in the intervention groups (p < 0.001). Among the C-CORE polyethylene cushions, Group D presented the lowest interface pressure (p<0.05).
Conclusion: the use of the air cell cushion had the lowest interface pressure, followed by one of the foam cushions and one of C-CORE polyethylene, new technology. There was a difference in pressure between the three C-CORE polyethylene cushions. The study was registered in the Brazilian Clinical Trials Registry, with number RBR-9vsvKn5.
DESCRIPTORS:
Technological development and innovation projects; Pressure; Wheelchairs; Pressure ulcer; Biomedical technology; Clinical nursing research; Nursing
RESUMO
Objetivo: comparar a pressão da interface nos indivíduos sentados em seis diferentes almofadas para cadeira de rodas.
Método: estudo clínico de fase I, realizado com 37 participantes em julho de 2024 no Laboratório de Tecnologia e Inovação, totalizando 222 avaliações. As almofadas foram alocadas para um grupo controle (A - células de ar) e cinco grupos intervenção (B e C - espuma de poliuretano; D, E e F - polietileno C-CORE). A variável independente foi o tipo de almofada, e a dependente, a pressão de interface. As variáveis de controle foram idade, sexo, altura, peso e circunferência do quadril, utilizando análise de covariância.
Resultados: a média de idade foi de 27,38 anos (±DP 10,39); 56,8 % eram homens, média de peso 72,6 kg (±DP 20); média da altura 1,70 m (±DP 0,11); média da circunferência do quadril 101,1 cm (±DP 12,6). A média de pressão variou de 3.735,1 mmHg a 5.380,8 mmHg. Comparações múltiplas entre os grupos revelaram que a almofada do grupo A (controle) apresentou valores significativamente menores de pressão em comparação às almofadas dos grupos intervenção (p < 0,001). Dentre as almofadas de polietileno C-CORE, a do Grupo D apresentou menor pressão de interface (p<0,05).
Conclusão: o uso da almofada de células de ar teve menor pressão de interface, seguida de uma das almofadas de espuma e uma de polietileno C-CORE, nova tecnologia. Houve diferença na pressão entre as três almofadas de polietileno C-CORE. Estudo foi registrado no Registro Brasileiro de Ensaios Clínicos, sob número RBR-9vsvKn5.
DESCRITORES:
Projetos de desenvolvimento tecnológico e inovação; Pressão; Cadeiras de rodas; Lesão por pressão; Tecnologia de cuidados de saúde; Pesquisa em enfermagem clínica; Enfermagem
RESUMEN
Objetivo: comparar la presión de la interfaz en personas sentadas en seis cojines de sillas de ruedas diferentes.
Método: estudio clínico de fase I, realizado con 37 participantes en julio de 2024 en el Laboratorio de Tecnología e Innovación, totalizando 222 evaluaciones. Los cojines se asignaron a un grupo de control (A - celdas de aire) y cinco grupos de intervención (B y C - espuma de poliuretano; D, E y F - polietileno C-CORE). La variable independiente fue el tipo de cojín y la variable dependiente fue la presión de la interfaz. Las variables de control fueron edad, sexo, altura, peso y circunferencia de cadera, mediante análisis de covarianza.
Resultados: la edad media fue de 27,38 años (±DE 10,39); el 56,8 % eran hombres, peso medio 72,6 kg (±DE 20); altura media 1,70 m (±DE 0,11); circunferencia de cadera media 101,1 cm (±DE 12,6). La presión media osciló entre 3.735,1 mmHg y 5.380,8 mmHg. Múltiples comparaciones entre grupos revelaron que el cojín del grupo A (control) presentó valores de presión significativamente más bajos en comparación con los cojines de los grupos de intervención (p < 0,001). Entre los cojines de polietileno C-CORE, el Grupo D presentó la presión de interfaz más baja (p<0,05).
Conclusión: el uso del cojín de celda de aire tuvo la presión de interfaz más baja, seguido por uno de los cojines de espuma y uno de polietileno C-CORE, nueva tecnología. Hubo una diferencia de presión entre los tres cojines de polietileno C-CORE. El estudio fue registrado en el Registro Brasileño de Ensayos Clínicos, con el número RBR-9vsvKn5.
DESCRIPTORES:
Proyectos de desarrollo tecnológico e innovación; Presión; Sillas de ruedas; Úlcera por presión; Tecnología biomédica; Investigación en enfermería clínica; Enfermería
INTRODUCTION
Wheelchair users are at higher risk of developing pressure ulcers because they are confined to a sitting posture for prolonged periods. Prevention requires discharge with suspension of the body itself or constant interactions with the caregiver. When there is no assistance for the individual to move in the chair, the body will develop an ulcer due to the constant pressure and weight on the soft tissues (skin, subcutaneous tissue, and muscle)1.
The frequency of weight transfers for wheelchair users is critical for tissue perfusion and should be performed every 15-30 minutes. This requires constant monitoring by the user and the healthcare professional2. Wheelchair users should be provided with and use specialized cushions for positioning and skin protection. While cushions provide some pressure redistribution, a weight transfer mitigation strategy is required to offload additional pressure on high-risk areas3.
A wheelchair cushion is commonly used to manage pressure created when individuals with mobility or sensation impairment remain seated2. In less resourced settings, 80 % of people with spinal cord trauma die from pressure ulcer (PU) complications within two years. Therefore, the wheelchair cushion acts as a complement to the buttock soft tissue to reduce focal high pressure under the bony prominences and distribute the pressure evenly throughout the contact area4. Properly prescribed cushions are effective in reducing the incidence and severity of pressure injuries5.
Cushions can be categorized, according to the filling material, as of foam, gel, and air. Wheelchair cushions filled with the same type of material can vary widely in design, such as a foam cushion with a flat, contoured, or segmented design, or an air cushion with segmented air cell or individual air membrane4.
The National Commission for the Incorporation of Technologies (CONITEC) of the Brazilian Public Health System (SUS) established the incorporation of seat cushions with air cells to prevent pressure injuries. Cushions with interconnected air cells were inserted into the SUS Table of Procedures, Orthoses, Prostheses and Medications, to prevent pressure ulcers6.
Studies have compared different wheelchair cushions in terms of their interface pressure-reducing effect. However, some reported better effect of the air cushion compared to other cushions; others reported better effect of the foam cushion compared to the gel cushion7-8. Inconsistencies between studies limit healthcare professionals in implementing evidence-based clinical practices.
Developing new wheelchair cushions has become a challenge for manufacturers in recent years. In particular, interface pressure reduction properties, microclimate control and effects on user comfort are important factors in evaluating a new product. In 2022, production of C-CORE technology began in Brazil, developed from long-chain polyethylene filaments, which give the material high flexibility and resistance. This innovation resulted in the launch, from 2023 and 2024, of wheelchair cushions on the national market.
Cushions developed with C-CORE technology promise to provide more comfort and protection against injuries for wheelchair users. The hypothesis of this study was that air cell, foam, and C-CORE polyethylene cushions would have similar interface pressures. The results and analyses of this research will contribute to the identification of the most appropriate type of cushion, providing technical support to healthcare professionals in clinical indications and directly benefiting wheelchair users, who are primarily interested in products supported by scientific evidence. Therefore, this study was developed to compare the interface pressure on individuals sitting on six different wheelchair cushions.
METHOD
This is phase I of a non-randomized, comparative, unmasked clinical study to elucidate the hypothesis: polyethylene (C-CORE), polyurethane (foam), and air cell cushions have the same effectiveness in reducing interface pressure. For the communication of the study, the assumptions of the statement CONsolidated Standards of Reporting Trials (CONSORT), specifically from Template for intervention description and replication (TIDieR), were considered. This is an extension on how to describe the interventions of a clinical trial. The study tested six cushions, all new, with no signs of wear and tear, with covers provided by the manufacturer. The cushions were allocated into the control group (air cell cushion) and five intervention groups (two groups with foam cushions and three groups with C-CORE polyethylene cushions) (Figure 1). The main outcome was interface pressure in the sitting position.
The interconnected air cell cushion was selected for the control group (A), as per CONITEC's recommendation for pressure injury prevention. In the intervention groups, two polyurethane foam cushions (B, C) and three polyethylene C-CORE cushions (D, E, F) were included. All cushions are produced and sold in Brazil. To protect the companies, the original name was replaced by Roman numerals.
Characteristics of the cushions in the control group (A) and intervention groups (B, C, D, E, F). Belo Horizonte, MG, Brazil, 2025.
In the control group, the cushion consists of interconnected air cells; therefore, the density parameter does not apply. It was calibrated using a volunteer weighing 66 kg (145.5 lbs) as a reference. The weight definition was based on preliminary evaluations with the participation of five volunteers: 39.3 kg (86.7lbs); 49.4 kg (109 lbs); 66.0 kg (145.5 lbs); 73.4 kg (162 lbs); 105.4 kg (232.4 lbs). After organizing the data in ascending order, the median was identified as 66.0 kg, a value adopted as the calibration parameter for the cushion. This decision was confirmed by identifying that this calibration was able to redistribute pressure when individuals of all the weights mentioned sat on this cushion.
The cushion model with cells interconnected by channels that regulate and transfer air from one cell to another balances the body weight when the user is sitting. The cushion has two independent pressure adjustment regions, each equipped with an air valve, which allows the user to adjust the pressure to compensate for positioning or ensure greater stability when sitting in the wheelchair.
The sample size was determined based on the need to detect significant differences between the interface pressures of the different cushions evaluated. The hypothesis assumed was that cushion A (air cells), cushions B and C (foam), and cushions D, E, F (C-CORE polyethylene) present similar interface pressures, considering that all were developed to redistribute pressure in regions of bony prominence. For this, a minimum of 30 people was established. This number refers to phase I of a clinical study, in which the developed product is tested on a group of 20 to 100 volunteers without comorbidities or complications, with the aim of evaluating the safety, compatibility, and efficacy of the product9.
Recruitment was carried out between May and June 2024, based on an invitation on social media. After contacting us via email, interested parties completed a form on Google Forms® with personal data and eligibility criteria, and informed the most suitable day and time for the interview. Participants of both sexes, healthy, over 18 years of age, with all limbs, movement independence that allows the person to move autonomously and without restrictions, and weighing up to 120 kg were included. Patients reporting urinary or fecal incontinence, presence of marked spinal deviation on inspection, desquamative dermatological diseases, skin wounds or scars in the gluteal region were excluded.
Participants visited the physical space of the research laboratory from May to June 2024, where they received explanations about the study and had the opportunity to clarify any doubts they might have. In addition, one of the researchers measured weight, height, and hip circumference using a scale, tape measure and soft measuring tape, respectively.
The dependent variable was the interface pressure, and the independent variable was the type of cushion, with six groups: air cells (group A - control); polyurethane foams (groups B and C - intervention); and C-CORE polyethylene (groups D, E and F - intervention). The following control variables were also considered: age (full years); sex; height (in meters); weight (in kilograms); hip circumference (in centimeters); Body Mass Index (BMI) (kg/m²). Subsequently, BMI was classified as underweight (<18.5 kg/m²), adequate weight (≥18.5 and <25 kg/m²), overweight (≥ 25 and < 30 kg/m²), and obesity (≥30 kg/m²).
Data collection took place in July 2024 with the cushions from the control group and intervention groups. The study was carried out at the Technology and Innovation Laboratory, located at the nursing school of the Universidade Federal de Minas Gerais. The environment was maintained at a temperature of 23°C. Each cushion was placed on the same rigid, flat surface, with the height adjusted so that the participant could keep their feet flat on the floor. The clothing consisted of shorts or light trousers, such as leggings, no back pocket or stitching.
To evaluate the outcome (interface pressure), a SR Soft Vision ® sensor, which is a blanket made of tiny cells that capture the magnitude of pressure and the contact area of the person's body surface, converting it into data through software compatible with Windows ®. For this study, pressure points equal to and above 79 mmHg were considered, classified as high, according to the manufacturer's recommendation. To calculate the total pressure, all high pressure points were added together.
A tape measure was used to maintain body alignment, and a goniometer was used to measure the angle of the joints and ensure the desired positioning. The participant was positioned sitting with buttocks and thighs supported. It is important that the anthropometry of the pelvis is well-positioned, so that the load is transferred from the inferior position of the ischial tuberosities to other anatomical surfaces that support load2. The head was positioned facing forward, shoulders aligned and relaxed, straight torso without backrest, knees separated at the same distance as the hips, knee joint at 90 degrees, with feet resting on the floor. After positioning the participant on each cushion, they waited one minute to record the photo generated by the sensor on the software. The thorough assessment of body alignment provided each individual with the ability to consistently reproduce the position guided by the evaluator, so that there was no deviation from the positioning.
A database was created in the Microsoft Excel ® 2019, where data were released during its collection. Subsequently, after the conference, the data was transferred to the software Statistical Package for the Social Sciences, version 21.0, to perform analyses and generate results. This step was carried out by a doctor with a degree in statistics.
To compare the total pressure between the different types of cushions, Analysis of Variance with several factors was used. This model provides a comparison of the outcome with the variable that defines the groups (in this case, the total pressure per cushion), adjusting for possible confounding factors (in this case, the adjusted confounding variables were sex, weight and height). When significant differences were detected between groups, DSM multiple comparison tests were performed and line graphs were created with the marginal means of the groups to illustrate the results. A subanalysis was performed, considering only the three C-CORE cushions, using the same tests mentioned above. In all analyses, a significance level of 5 % was considered.
The study was approved by the Research Ethics Committee. All participants signed the Free and Informed Consent Form. The research was registered in the Brazilian Clinical Trials Registry database, with number RBR-9vsvKn5.
RESULTS
Figure 2 presents the CONSORT diagram for selecting study participants8. Fifty participants were recruited for the study. Of these, 47 were eligible and ten were excluded in the evaluation process. Thus, the 37 participants who took part in the study were allocated to the control group and the five intervention groups. There was no loss to follow-up in the groups. At the end of the study, the 37 participants per group were analyzed, totaling 222 evaluations, with 37 evaluations performed per cushion.
The age of participants ranged from 18 to 53 years, with a mean of 27.38 years (standard deviation 10.39) and a median of 24 years. Furthermore, 16 (43.2 %) were women and 21 (56.8 %) were men. Body weight ranged from 43.3 kg to 115.9 kg, with a median of 74.2 kg and an average of 72.6 kg (standard deviation 20.0). The Body Mass Index presented values between 15.71 kg/m² and 43.09 kg/m², being categorized as: 6 (16.2 %) - underweight; 13 (35.1 %) - normal weight; 11 (29.7 %) - overweight; and 7 (18.9 %) - obesity. Hip circumference ranged from 79 cm to 131.5 cm, with a median of 102 cm and a mean of 101.1 cm (standard deviation 12.6). Height ranged from 1.53 m to 1.94 m, with a median of 1.69 m and mean of 1.70 m (standard deviation 0.11).
The interface pressure was compared between the control and intervention groups (Table 1 and Figure 3), the result of which confirmed a significant difference between the groups (p value<0.001), with lower pressure levels for group A (Control).
Graph of marginal means of total pressure (mmHg) by group (cushion type). Belo Horizonte, MG, Brazil, 2024.
Considering the multiple comparison tests (Table 2), there was a significant difference between group A (control) and the intervention groups (B, C, D, E, F). In all groups, lower mean pressure values were observed for group A (control).
Multiple comparison tests were performed with the intervention groups (D, E, F) regarding the C-CORE polyethylene cushions (Table 3), as this is a technological innovation.
The results presented significant difference between group D and the other groups (E, F) with C-CORE polyethylene cushions. Group D had an average pressure 414.5 mmHg lower than group E and 423.3 mmHg lower than group F.
DISCUSSION
Choosing the right wheelchair seat is an important step in preventing pressure ulcers. In the study carried out, the air cell cushion (group A) showed the best capacity to reduce pressure, followed by one of the foam cushions (group B) and another of C-CORE (group D). These three cushions were superior to the other cushions, made of polyurethane foam (group C) and C-CORE polyethylene (groups E and F). The result is similar to that of the review, which included ten studies. The air cushion has been shown to be more effective in reducing interface pressure than gel and foam cushions⁴.
The aforementioned review did not analyze the study of the C-CORE polyethylene cushion. This is due to the lack of publications about the product, considering that this cushion is the result of technological innovation and its commercialization for wheelchairs began in 2023. The research results confirm that one of the C-CORE polyethylene cushions may be another option for preventing pressure injuries, as it is a new technology commercially available in Brazil. However, it was possible to notice that there is a difference in the performance of these cushions depending on their firmness.
Air cell cushions provide satisfactory pressure relief due to the person's immersion, provided the amount of inflated air is regulated in accordance with the manufacturer's recommendations. This device is recommended for wheelchair users who are unable to adjust their posture independently, are at high risk of developing pressure injuries, or already suffer from these conditions6. However, air cushions are not widely used by wheelchair users in various segments of society due to their high cost. They have the disadvantage of being able to be pierced with a piercing instrument or surface.
Wheelchair air cushions need to have a reservoir for the air to inflate properly, so that they are effective in distributing pressure. One vulnerability of these cushions is their poor stability, caused by the rapid movement of air between the cells. Therefore, a flat and rigid base is necessary for its effectiveness10. In the research carried out, the tested cushions were positioned on the same rigid surface, a fact that may have contributed to the better performance of the air cell cushion in relation to the other cushions evaluated.
The need for individual adjustment of the air cell cushion according to the user is a limitation to its use10. This fragility is worse for wheelchair users who have impaired mobility and sensitivity. Aiming at solving this problem, new projects have been developed by manufacturers.
Data obtained by finite element analysis were used to simulate the inflation and deflation of soft bubble air cells. The control systems of a single air cell and the entire cushion were designed and simulated to create a seat cushion capable of recognizing zones of higher and lower risk of pressure injury generation while providing automatic compensation11.
Another dynamic cushion proposal that features a design to detect areas of high pressure and act to relieve that pressure was the use of resistive sensors in a grid formation to map the pressure in the seat. To relieve pressure, a grid of custom pneumatic bladders (cells) was proposed to inflate in response to sensor thresholds, redistributing pressure. They were selected in the geometric shape of a torus (circle) to optimize durability, stability and increase breathability in the final design. The cushion's customized design allows users to dynamically relieve pressure, eliminating the need to constantly readjust the position12.
A systematic review, published in 2024, on the effectiveness of pressure-relieving cushions found that most comparison studies typically address a specific population, such as spinal cord injured patients, or only certain cushion design/materials styles. The results suggest that air cell cushions provide optimal pressure relief and shear reduction7. However, discharge cushions provide superior pressure relief than air cell cushions7,12, but require further research for greater generalizability2,7. Other results suggest that cushions made of polyurethane foam13, open-cell polyurethane foam blocks of variable-hardness, and open-cell polyurethane foam cushions appear to provide more effective pressure relief than those injected with polyurethane foam and gel8. Until then, there are doubts about the best cushion for pressure ulcer prevention or aid in healing if it exists. Therefore, knowledge about the ability of new technologies to reduce pressure brings the possibility of yet another option that can be used by people at risk of pressure injuries14.
Regarding C-CORE polyethylene cushions, studies published in the literature are still incipient. The results of this research contribute to the advancement of knowledge by presenting a new technology for preventing pressure injuries in wheelchair users. The three cushions with C-CORE technology (D, E, F) are 7 cm high, but with different firmness. Cushion D, which was the least firm, was the most effective in reducing interface pressure when compared to the other two with the same composition. The effect size (pressure reduction) was similar to that of the air cell cushion. The result confirms that there is a difference in the ability to reduce interface pressure within the C-CORE cushions, and this may be related to the cushion firmness. C-CORE wheelchair seat cushions with lower densities are suspected to have better pressure distribution than higher densities. However, further studies are required to generalize the information.
Flat polyurethane foam, although more easily found on the market and at more affordable prices, is not effective in preventing pressure injuries when compared to other types of cushions4. Any cushion that has immersion characteristics and contours to the buttock-thigh complex consistently outperforms flat foam cushions in reducing interface pressure7.
Polyurethane foam cushions have differences in their structure. A stiffer foam is formed when there is a greater degree of crosslinking between the polyurethane polymer chains and the density is higher. Foam becomes more flexible when there is less crosslinking and density is lower15. Another relevant aspect is the higher the density of a polyurethane foam, the greater its resistance16. This statement does not apply when it comes to memory foam. The foam cushions in the study (B and C) had distinct characteristics in terms of size, including height and density.
An important fact is the way the cushions are manufactured. Those made of open-cell polyurethane may be more effective in potentially redistributing interface pressure than seat cushions made of gel-injected closed-cell polyurethane foam17. However, manufacturing features do not appear to have a major impact on thermal response or perceived comfort8.
The interface pressure between the body and the wheelchair cushion, measured by the pressure mapping system and presented as color-coded numerical values, is a commonly used parameter to present the effect of pressure reduction4. This parameter is crucial given the numerous cushions available on the market, as it is essential to have clear and concise information to allow decision-making consistent with the user's needs.
In this study, the sensor SR Soft Vision ® was used to check the pressure at the interface. Pressure mapping is a clinical tool that has been used to assess the pressure distribution of the human body on support surfaces, as it allows visualization and quantification of such distribution8. The use of pressure maps to interpret interface pressures, assessed by experienced or less experienced operators, is a reliable method17. Individualized assessment of interface pressure is suggested for wheelchair cushion prescription by clinic professionals4,18. It is necessary to consider the preservation of the skin's microclimate and the stability of the cushion, since air cell cushions are considered unstable19.
This study has some limitations, such as the lack of individual calibration of the interconnected air cell cushion, even though it was superior to the other cushions evaluated. Another point to be considered was the use of a rigid surface where all the cushions were supported instead of the wheelchair. However, this conduct was intended to parameterize the test environment, considering that each cushion manufacturer has a specific wheelchair, including a different weight capacity. It is also worth noting that the material used in the cushion covers was not taken into consideration in this research.
Further research with larger groups is needed to verify the effectiveness of C-CORE polyethylene cushions, considering differences in material firmness, in reducing pressure in compressed areas (bony prominences) and improving the skin microclimate. To assess participants' experience using the new C-CORE technology, a feedback questionnaire should be included about the sensations when using the C-CORE polyethylene cushion. Furthermore, the clinical study must continue in phase II to evaluate efficacy in the real population.
In contrast, this study contributes to the advancement of knowledge by presenting results of interface pressure with the use of wheelchair cushions with a new technology called C-CORE, opening the possibility for the product to be safely incorporated into clinical practice.
CONCLUSION
The hypothesis of similarity among the groups was not confirmed, considering that there was a statistical difference in the interface pressure between the air cell cushion of the control group (group A) and the foam and polyethylene cushions of the intervention groups. The use of the air cell cushion had the lowest interface pressure, followed by one of the foam cushions (group B) and one of C-CORE polyethylene (group D), the new technology evaluated. Among the C-CORE polyethylene cushions (D, E, F), that of Group D presented the lowest interface pressure.
ACKNOWLEDGMENT
The authors would like to acknowledge the Research, Development, and Innovation (RD&I) partnership agreement between the Nursing School of the Universidade Federal de Minas Gerais and C-CORE Indústria e Comércio de Artefatos Plásticos LTDA to support this project, and the National Council for Scientific and Technological Development (CNPq) for funding an Undergraduate Research Project scholarship (PIBIC). The authors appreciate the valuable assistance of volunteers in completing this study.
REFERENCES
-
1 Xu J, Jiao Y, Wang N, Xu X, Yang L, Han L, et al. Incidence of pressure injuries in patients with spinal cord injury: A systematic review and meta-analysis. J Tissue Viability [Internet]. 2025 [cited 2025 Jul 12];34(2):100881. Available from: https://doi.org/10.1016/j.jtv.2025.100881
» https://doi.org/10.1016/j.jtv.2025.100881 -
2. Osuagwu B, McCaughey E, Purcell M. A pressure monitoring approach for pressure ulcer prevention. BMC Biomed Eng [Internet]. 2023 [cited 2025 Jul 12];5(1):8. Available from: https://doi.org/10.1186/s42490-023-00074-6
» https://doi.org/10.1186/s42490-023-00074-6 -
3. Fadil R, Hoffmann B, Lovelace S, Farahani B, Arzanpour S, Loscheider J, et al. Design and evaluation of a dynamic air cushion for pressure ulcers prevention. J Tissue Viability [Internet]. 2022 [cited 2024 Dec 12];31(3):491-500. Available from: https://doi.org/10.1016/j.jtv.2022.04.004
» https://doi.org/10.1016/j.jtv.2022.04.004 -
4. He C, Shi P. Interface pressure reduction effects of wheelchair cushions in individuals with spinal cord injury: A rapid review. Disabil Rehabil [Internet]. 2022 [cited 2024 Dec 12];44(6):827-34. Available from: https://doi.org/10.1080/09638288.2020.1782487
» https://doi.org/10.1080/09638288.2020.1782487 -
5. Smith EM, Danielson AJ, Howich RL, Dhariwal A, Miller WC. Reliability of cushion construction for a low-cost pressure-reducing wheelchair cushion for less-resourced settings. Disabil Rehabil Assist Technol[Internet]. 2024 [cited 2024 Dec 11];5:1-5. Available from: https://doi.org/10.1080/17483107.2024.2436637
» https://doi.org/10.1080/17483107.2024.2436637 -
6. Comissão Nacional de Incorporação de Tecnologias no SUS (CONITEC). Relatório nº 84. Ministério da Saúde do Brasil [Internet]. 2014 [cited 2024 Dec 16]. Available from: http://antigo-conitec.saude.gov.br/images/Incorporados/MateriaisEspeciais-FINAL.pdf
» http://antigo-conitec.saude.gov.br/images/Incorporados/MateriaisEspeciais-FINAL.pdf -
7. Damiao J, Gentry T. A systematic review of the effectiveness of pressure relieving cushions in reducing pressure injury. Assist Technol [Internet]. 2024 [cited 2024 Dec 10];36(5):373-7. Available from: https://doi.org/10.1080/10400435.2021.2010148
» https://doi.org/10.1080/10400435.2021.2010148 -
8. García-Molina P, Casasus SR, Sanchis-Sánchez E, Balaguer-López E, Ruescas-López M, Blasco JM. Evaluation of interface pressure and temperature management in five wheelchair seat cushions and their effects on user satisfaction. J Tissue Viability [Internet]. 2021 [cited 2024 Dec 6];30(3):402-9. Available from: https://doi.org/10.1016/j.jtv.2021.05.004
» https://doi.org/10.1016/j.jtv.2021.05.004 -
9. Naud L. Perfil dos ensaios clínicos submetidos para apreciação ética da Comissão Nacional de Ética em Pesquisa entre 2015 a 2019. Braz J Forensic Sci Med Law Bioeth [Internet]. 2021 [cited 2025 Jul 13];10(2):164-77. Available from: https://doi.org/10.17063/bjfs10(2)y2021164-177
» https://doi.org/10.17063/bjfs10(2)y2021164-177 -
10. Jiang X, Guo L, Lin Y, Ma X, Song Y, Ma J. The influence of a contoured seating base on pressure distribution and discomfort. Disabil Rehabil Assist Technol [Internet]. 2021 [cited 2025 Jul 12];16(7):749-57. Available from: https://doi/org.10.1080/17483107.2021.1892841
» https://doi/org.10.1080/17483107.2021.1892841 -
11. Mannella D, Bellusci M, Graziani F, Ferraresi C, Muscolo GG. Modelling, design and control of a new seat-cushion for pressure ulcers prevention. Proc Inst Mech Eng H [Internet]. 2022 [cited 2024 Dec 12];22:9544119211068908. Available from: https://doi.org/10.1177/09544119211068908
» https://doi.org/10.1177/09544119211068908 -
12. Robinson J, Shewalkar V, Rigo I, Rock A, Cinnamon L, Chapman-Rienstra D, et al. Design of a custom sensing and actuating cushion for use in pressure relief in wheelchair users. Proceedings of the 2023 Design of Medical Devices Conference; 2023 April 17-19; Minneapolis, MN, USA. The American Society of Mechanical Engineers [Internet]. 2023 [cited 2024 Dec 12]. Available from: https://doi.org/10.1115/DMD2023-6305
» https://doi.org/10.1115/DMD2023-6305 -
13. Bogard F, Polidori G, Murer S, Maalouf C, Blancheteau Y, Quinart H, et al. Hygro-thermo-mechanical performance of wheelchair cushion technologies in the prevention of pressure ulcers and moisture-associated skin damages. Assist Technol [Internet]. 2023 [cited 2025 Jul 12];35(1):64-73. Available from: https://doi.org/10.1080/10400435.2021.1949406
» https://doi.org/10.1080/10400435.2021.1949406 -
14. De León-Hernández A, Martínez-Hernández A, Bolivar-Tellería I, Bosch-Sánchez A, Cabrera-Padilla MF, López-López CO. A Method for custom-contoured cushion fabrication based on pressure mapping for wheelchair users to prevent pressure ulcers: Feasibility quasi-experimental study. JMIR Rehabil Assist Technol [Internet]. 2025 [cited 2025 Jul 12];12:e68612. Available from: https://doi.org/10.2196/68612
» https://doi.org/10.2196/68612 -
15. Wang Z, Wang C, Gao Y, Li Z, Shang Y, Li H. Porous thermal insulation polyurethane foam material. Polymers [Internet] 2023 [cited 2024 Dec 14];15(18):3818. Available from: https://doi.org/10.3390/polym15183818
» https://doi.org/10.3390/polym15183818 -
16. Dong H, Li S, Jia Z, Luo Y, Chen Y, Jiang J, et al. A review of polyurethane foams for multi-functional and high-performance applications. Polymers [Internet]. 2024 [cited 2025 Jul 12];16(22):3182. Available from: https://doi.org/10.3390/polym16223182
» https://doi.org/10.3390/polym16223182 -
17. Arumugam S, Ranganathan R, Ravi T. Need for customisation in preventing pressure ulcers for wheelchair patients-a load distribution approach. Int J Biomed Eng Technol [Internet]. 2022 [cited 2025 Jul 12];38(1):44-64. Available from: https://doi.org/10.1504/IJBET.2022.120862
» https://doi.org/10.1504/IJBET.2022.120862 -
18. Furumasu J, Buckner R, Mata C, Requejo P. Off-loading pressure relief with foam cut out cushions: Experiences from Rancho Los Amigos National Rehabilitation Center. J Rehabil Med Clin Commun [Internet]. 2023 [cited 2025 Jul 12];6:18706. Available from: https://doi.org/10.2340/jrmcc.v6.18706
» https://doi.org/10.2340/jrmcc.v6.18706 -
19. Couzens L, Peterson B, Innes E, Stevens CJ. The effect of wheelchair cushion properties on the microclimate at the cushion-user interface: A systematic review and meta-analysis. Aust Occup Ther J [Internet]. 2024 [cited 2024 Dec 13];71(4):612-26. Available from: https://doi.org/10.1111/1440-1630.12932
» https://doi.org/10.1111/1440-1630.12932
NOTES
-
APPROVAL OF ETHICS COMMITTEE IN RESEARCH
Approved by the Research Ethics Committee of the Universidade Federal de Minas Gerais, opinion no. 6.853.674, Certificate of Presentation for Ethical Assessment (CAAE) 78828624.3.0000.5149
-
TRANSLATED BY
Denise Costa Rodrigues
-
DATA AVAILABILITY
The data supporting this study are confidential and not publicly available, as they derive from a Research, Development and Innovation (RD&I) Project carried out in public-private partnership with the company C-CORE Brasil.
Edited by
The data supporting this study are confidential and not publicly available, as they derive from a Research, Development and Innovation (RD&I) Project carried out in public-private partnership with the company C-CORE Brasil.
Source: Prepared by the authors, 2025.
